IVF medication and monitoring log Record the plan your own clinic gives you WithViv Resource Edition V2 | Owner-review draft | October 2026 Educational support from Viv Vivanco. Your own care-team instructions come first. SECTION 1 Set up your record before you need it For tracking prescribed fertility medicines, monitoring visits and changes. This log does not choose a medicine, dose, injection site or treatment schedule. Keep the clinic’s current written instructions with it. How to use these pages - Page 2: one confirmed medicine order. Duplicate for each medicine or change. - Page 3: actual doses given. Reprint as needed; record after use. - Page 4: results and confirmed changes. Keep older orders marked replaced. - Page 5: supplies, safety and sources. Follow product-specific training. Initials or private identifier, optional ____________________________________________________________ Cycle or plan name from clinic ____________________________________________________________ Clinic and clinician ____________________________________________________________ Cycle start date, if relevant ____________________________________________________________ Daytime contact ____________________________________________________________ After-hours or urgent contact ____________________________________________________________ Pharmacy contact ____________________________________________________________ Clinic’s usual response window ____________________________________________________________ Where my current written orders and injection teaching are stored ____________________________________________________________ If an instruction is missing or does not match Contact the clinic or dispensing pharmacist to reconcile it before using the medicine. Ask for the medicine name, exact dose with units, route, timing and preparation steps in writing. Do not convert units, borrow someone else’s plan or guess. Keep completed logs private. If you share them, use the secure route your clinic recommends. SECTION 2 One current medicine order One medicine and one order version per page. Copy from the clinic’s instructions and product label; ask the clinic or pharmacist to resolve any mismatch. Do not calculate a dose from this worksheet. Medicine name and formulation ____________________________________________________________ Order date and version ____________________________________________________________ Strength or concentration exactly as labeled ____________________________________________________________ Dose exactly as ordered, including units ____________________________________________________________ Route exactly as ordered ____________________________________________________________ Clinic-taught site, if relevant ____________________________________________________________ Scheduled time with AM/PM and time zone ____________________________________________________________ Start date and stop/change instructions ____________________________________________________________ Preparation, mixing or device instructions: written source or training reference ____________________________________________________________ Storage, after-opening limits and expiry: label or pharmacist instructions ____________________________________________________________ Order source: clinician, portal or call ____________________________________________________________ Received date and time ____________________________________________________________ Read-back or confirmation: exact instructions confirmed with whom and when ____________________________________________________________ Current order replaces this earlier order ____________________________________________________________ Confirmed by ____________________________________________________________ Time-critical medicine: if your clinic calls this a trigger or gives an exact administration time, write the full date, time and time zone below. Ask who to call if you cannot follow it exactly. Time-critical date and exact time ____________________________________________________________ Contact for a timing problem ____________________________________________________________ Verify the product against the confirmed order. Do not convert units. SECTION 3 Record each actual dose Complete after administration. Use the order page to verify the medicine and dose. Write units every time. If a dose is late, missed, spilled, vomited or uncertain, contact the clinic promptly; do not repeat, double or change a dose on your own. [4] Entry 1 Date and planned time, AM/PM + zone ____________________________________________________________ Actual date and time, AM/PM + zone ____________________________________________________________ Medicine and order version ____________________________________________________________ Dose given, with exact units ____________________________________________________________ Route and clinic-taught site used ____________________________________________________________ Given by / initials ____________________________________________________________ Issue, symptoms or clinic advice; contact and time if relevant ____________________________________________________________ Entry 2 Date and planned time, AM/PM + zone ____________________________________________________________ Actual date and time, AM/PM + zone ____________________________________________________________ Medicine and order version ____________________________________________________________ Dose given, with exact units ____________________________________________________________ Route and clinic-taught site used ____________________________________________________________ Given by / initials ____________________________________________________________ Issue, symptoms or clinic advice; contact and time if relevant ____________________________________________________________ Unsure whether a dose was given? Record the uncertainty and call the clinic. A blank or checked box is not proof of administration. SECTION 4 Monitoring and confirmed changes Visit date and time ____________________________________________________________ Tests or checks performed ____________________________________________________________ Results exactly as reported, with units and report source ____________________________________________________________ What the team explained; questions still open ____________________________________________________________ A change is only a plan when it is confirmed Medicine or instruction being changed ____________________________________________________________ Who gave the instruction ____________________________________________________________ Instruction received date and time ____________________________________________________________ Change takes effect date and time ____________________________________________________________ New exact instruction, including dose units, route and timing if relevant ____________________________________________________________ Read-back: what I repeated and what the team confirmed ____________________________________________________________ Written confirmation location ____________________________________________________________ New order-page version ____________________________________________________________ Next visit, test or call ____________________________________________________________ Preparation the clinic requested ____________________________________________________________ Do not change treatment because a lab value looks high or low, or because someone else had a different result. Ask your team what it means for your plan. Keep the original report rather than relying on this summary. SECTION 5 Supplies, questions and safety Medicine or supplies to refill ____________________________________________________________ Date I need them, allowing delivery time ____________________________________________________________ Pharmacy contacted and date ____________________________________________________________ Delivery or pickup confirmed ____________________________________________________________ Questions for nurse or pharmacist: device, storage, mixing, disposal or reactions ____________________________________________________________ Keep medication teaching specific - Use only the route, equipment and site your own team taught for that medicine. This log intentionally contains no injection map. - Follow the product label and pharmacist’s storage instructions. Do not assume every medicine can be warmed or left out. - Never reuse or share needles or syringes. Follow the product-specific device instructions. Put used sharps promptly in an appropriate sharps container and follow local disposal rules. [1] When something goes wrong For an incorrect, missed or uncertain dose, contact your clinic promptly and have the medicine, label, dose and times ready. Do not improvise a replacement dose. After stimulation, contact your clinic urgently for worsening abdominal swelling or pain, repeated vomiting, trouble keeping fluids down, or much less urine. For severe trouble breathing, chest pain, fainting, uncontrolled bleeding, or sudden severe abdominal pain, call 911 or seek emergency care now. [2,3] Sources and scope A blank organization tool, not medical advice or injection training. No clinician approval is claimed. Your current confirmed clinic orders and product-specific instructions govern treatment. [1] FDA • Safely using sharps https://www.fda.gov/medical-devices/safely-using-sharps-needles-and-syringes-home-work-and-travel/sharps-disposal-containers [2] ReproductiveFacts • Ovarian hyperstimulation syndrome https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-hyperstimulation-syndrome-ohss/ [3] MedlinePlus • When to use the emergency room https://www.medlineplus.gov/ency/patientinstructions/000593.htm [4] DailyMed • GONAL-F patient instructions https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?lang=en&setid=ae85b9c3-e7eb-4981-a5d9-346050e8f189 Sources checked October 1, 2026. [1–4] follow the order above.