You realize the time has passed. The vial is still in the fridge. The first feeling is usually panic, then a scramble for what to do next.
This is common. Clinics see it every cycle. The right next step is almost always the same: contact your clinic before you decide anything about the dose itself.
Call the clinic first
Most fertility clinics have an after-hours or on-call number for exactly this situation. Use it. Do not wait until the next business day if you are unsure what the delay means for your protocol.
When you call, have ready:
- Which medication and the scheduled time
- How late you are
- Whether any of the dose went in (or none)
- Where you are in the cycle (early stim, late stim, antagonist, luteal support)
The nurse or on-call doctor will tell you what to do for your protocol. Advice that works for one person on day 3 of stim may not apply on day 9 or for a different drug.
Do not double the dose on your own
Manufacturer guidance and clinic FAQs are consistent on this point: do not take two doses to “make up” for a missed one unless your clinic explicitly tells you to. Doubling can change hormone levels in ways that are hard to correct mid-cycle.
If the dose partially leaked, or the pen misfired, or you are not sure how much went in, the same rule applies. Describe what happened and let the clinic decide.
Timing windows vary by medication
Stimulation injections (the daily gonadotropins) often have a wider practical window than the trigger shot. Clinic pages commonly note that a delay of a few hours on a stim dose is handled differently from a missed or late trigger.
The trigger is the most time-sensitive injection in most protocols because retrieval is timed from it. If the missed or late dose is the trigger, treat it as urgent and call immediately — even in the middle of the night.
Luteal-support injections (progesterone in oil or other forms) also have their own rules. Some clinics treat a short delay differently from missing the first dose after transfer. Again: the clinic’s instruction for your protocol is the only one that matters.
What people usually do while waiting for the reply
- Note the exact time you realized the miss and any details about leakage or partial delivery.
- Do not inject a second time while you wait unless the on-call nurse has already told you to.
- Keep the used supplies if there was a device problem; some pharmacies or manufacturers will replace a failed pen or vial when you report it promptly.
- If the clinic is closed and you cannot reach anyone, most people still avoid improvising a double dose and follow up at the first available hour.
Reducing the chance of a miss next time
A reliable reminder system helps. Phone alarms work, but they are easy to silence or overlook when the day is chaotic. Many people move the schedule into a dedicated tracker so each dose has a clear status (due, taken, skipped) and the history stays intact across days.
Cove is built for that job: medication scheduling and reminders, injection-site rotation, inventory so you do not run short mid-stim, and a place to log what actually happened without overwriting the previous cycle. It is not a medical device and it does not tell you what dose to take. It keeps the plan visible so fewer doses slip.
Download Cove on the App Store: https://apps.apple.com/app/id6788749556.
When the miss feels bigger than one dose
If you have already missed more than one consecutive day, or the miss is the trigger, or you are unsure whether the cycle can continue, the clinic will decide whether monitoring needs to move earlier, whether a dose adjustment is required, or whether the cycle should be paused. That decision is clinical. Your role is to report accurately and quickly.
For more on keeping the daily schedule straight, see IVF injection schedule: how to keep track. For the one injection that has the tightest window, see IVF trigger shot: why timing is tight and how people remember it. Practical questions about the app and what it does (and does not) do are on the FAQ.
If a dose is already late, call the clinic. Then, if you want a calmer way to see the rest of the protocol, Cove is available on the App Store: https://apps.apple.com/app/id6788749556.