The first appointment
The new patient appointment is the starting point — and often the hardest one to schedule, because it requires choosing a clinic first. It happens at the clinic or over video and runs about 90 minutes. The physician reviews goals, performs an ultrasound, and orders bloodwork to assess ovarian reserve.
This is where AMHAnti-Müllerian hormone — a blood test reflecting ovarian reserve. Higher levels suggest more eggs available. and AFCAntral Follicle Count — an ultrasound count of small resting follicles. Another key indicator of how many eggs might be retrieved. numbers come back. They're the two most important numbers in the entire process, and they arrive at this appointment. Understanding what they mean before the appointment helps put them in context when they do.
What I'd do differently
Get AMH and AFC tested before making any financial commitment. These numbers don't require starting a cycle — they just require a blood draw and an ultrasound. Knowing them first gives a clearer picture of what one cycle might realistically yield, which changes how the whole process looks financially and emotionally.
AMH and AFC — what the numbers mean
These two measurements together give the clearest available picture of ovarian reserve — how many eggs are likely to respond in a stimulated cycle. They don't predict the future, but they shape the protocol and set realistic expectations.
AMH
Anti-Müllerian Hormone
A blood test. Measures a hormone produced by follicles. Higher levels generally suggest more eggs available; lower levels suggest fewer. Doesn't change much cycle to cycle — a relatively stable indicator of where things stand.
AFC
Antral Follicle Count
An ultrasound measurement. A count of small resting follicles visible in both ovaries at the start of a cycle. Each one represents a potential egg for that cycle. Used alongside AMH to build a fuller picture.
Neither number guarantees an outcome. They inform the stimulation protocol — which medications, which doses — and help calibrate expectations about how many eggs might be retrieved. A low AMH doesn't mean a cycle won't work. A high AMH doesn't mean the outcome will be ideal. They're starting points, not conclusions.
My numbers
My AMH came back at 0.84 — below average for my age. That number changed the conversation about what to expect from a single cycle and how many cycles might be needed to bank a meaningful number of eggs. I wish I'd had it earlier, before I was already emotionally and financially invested.
From the journal: getting the 0.84 result and the follicle count that followed — written as they happened.
Orientation and injection training
The orientation class is typically online, runs about two hours, and covers everything: the stimulation protocol, injection technique for each medication, the retrieval process, consent forms, and storage plans. Injection training videos are linked for later reference.
This is where a lot of the confusion from online research gets resolved — and where new questions tend to surface. Having a list of questions ready going in makes the time more useful. The site you're reading right now exists partly because of what that two-hour class didn't cover.
Orientation happens before the cycle starts, but after the new patient appointment and coordinator meetings. The sequence matters — some things only make sense once the initial bloodwork and consultation are done.
From the journal: what orientation day was actually like.
The cycle reservation
At NYU Langone, a cycle start reservation is required before the cycle begins. It's made through the patient care coordinator and represents the anticipated Day 2 window. The coordinator calls about two weeks before the expected period to confirm.
The reservation is honored within a 7-day window of the confirmed date — so if the reservation is set for the 15th, any Day 2 between the 8th and the 22nd counts. This is the flexibility built in for natural cycle variation.
From my experience
I ended up on a waitlist for June after missing a May window, and spent several weeks not knowing if I'd get scheduled before July. That uncertainty was genuinely stressful — and entirely avoidable if I'd understood earlier how the reservation system worked and planned further ahead. Make the reservation earlier than feels necessary. Cycles fill up.
Day 1 and Day 2 — what they actually mean
Day 1 is the first day of full menstrual flow — not spotting, not staining. Full flow before midnight counts as Day 1. The action on Day 1 is simple: call the clinic to schedule the Day 2 monitoring appointment.
Day 2 is the appointment. Bloodwork and ultrasound to confirm the ovaries are suppressed and no cysts are present. If everything looks clear, injections start that evening. A personalized cycle calendar is given at this visit.
If your period starts at night
Don't call the clinic after-hours — there won't be anyone there for cycle scheduling. Call the next morning (Day 2) to schedule a Day 3 start instead. It is completely fine to begin the cycle on Day 3. This comes up more often than the materials suggest and it's not a problem.
At NYU Langone, cycle fees are due at the Day 2 or Day 3 appointment. If the cycle is cancelled after starting, fees already incurred for services rendered are still owed. Understanding this before Day 2 avoids surprises.
Medications and pharmacy research
Prescriptions go to the pharmacy of choice — the clinic sends them electronically. Medication costs vary significantly between pharmacies, sometimes by thousands of dollars for the same drugs. Calling around before the prescription is ready is worth the time.
Two things worth knowing before ordering: pick up only the first half of the medication order to start, and wait on the trigger shot until the nurse confirms which type is needed. Both of these reduce the risk of paying for medications that ultimately aren't used.
The full pharmacy research — which pharmacies to call, what questions to ask, and discount programs worth knowing about — lives on the Medications page. Worth reading before the prescription is ready, not after.
Cycle reservations at NYU Langone fill up. I ended up on a waitlist for June after missing the May window, and spent weeks not knowing if I’d get scheduled before July. Nobody told me the cycle start reservation was something I needed to book well in advance. It’s not like scheduling a regular appointment — there are limited slots and they go. Contact the coordinator about the reservation earlier than feels necessary.
Pre-cycle checklist
Everything that needs to be in place before Day 2. This isn't a rigid sequence — some of these happen simultaneously, and the order varies by clinic and circumstance. It's here so nothing gets missed.
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New patient appointment completed
AMH and AFC results in hand. Protocol discussion with the physician done.
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Prerequisite testing complete
All required bloodwork and any additional tests ordered by the clinic finished before the cycle starts.
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Coordinator meetings done
Protocol reviewed, financial picture understood, cycle fees discussed.
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Orientation attended
Injection training videos watched. Consent forms reviewed.
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Cycle reservation confirmed
Date confirmed with coordinator. Coordinator confirmation call received ~2 weeks before expected period.
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Pharmacy chosen and first-half medications ordered
Pharmacies called, prices compared, discount programs explored. First half of medications ordered and received. Trigger shot held until nurse confirms type.
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Calendar cleared for monitoring appointments
7–9am appointments possible for 10–14 consecutive days including weekends. Retrieval day arranged — someone confirmed to take you home.
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HSA/FSA, insurance, and benefits confirmed
Coverage understood. Any applicable benefits activated. Financial plan in place before fees are due on Day 2.
Audio note coming soon — what I'd tell someone who's about to make the first appointment.