Knocked Up Podcast - The Cycle Guide App with Dr Caroline Fiddler
Dr Caroline developed the CycleGuide App during treatment to keep track of treatment instructions on her phone.
Our guest today is Dr Caroline Fiddler, a medical doctor and new mother to baby Alice who was conceived via IVF.
IVF can be overwhelming and keeping track of appointments, self-injections, procedures etc only adds to this.
So, Caroline developed the CycleGuide App during treatment to keep track of treatment instructions on her phone.
It helped her stay organised, feel more in control and gave her some peace of mind during treatment.
Find Cycle Guide here
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
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Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Dr Raelia Lew:
Women’s Health Melbourne is an innovative, holistic fertility and women’s health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals.
Jordi Morrison:
Our handpicked expert team provides the ultimate care experience for our patients. Reach us at womenshealthmelbourne.com.au and follow us at Women’s Health Melbourne and at Dr Raelia Lew.
Hello and welcome to Knocked Up, the podcast about fertility and women’s health. You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI Fertility Specialist.
Welcome, Raelia.
Dr Raelia Lew:
Hi, Jordi. How are you?
Jordi Morrison:
I'm great, thank you. And today, we've got a guest — Dr Caroline Fiddler.
Welcome, Caroline.
Dr Caroline Fiddler:
Thank you so much, Jordi and Raelia. Great to be here.
Jordi Morrison:
So great to have you, Caroline. You’ve got quite an exciting innovation to introduce to our listeners today. It’d be great to start off with a little bit about you and how you got here. You're a trained medical doctor and also a new mum to baby Alice.
Dr Caroline Fiddler:
Yes. It’s been quite a process. I’m a doctor and I’ve also been through IVF. It took a couple of years and quite a few ups and downs. Eventually, I’ve now got seven-month-old baby Alice, which is wonderful.
That insight, both as a doctor and a patient, made me realise that there were a few things that could probably be improved when supporting patients through their experience.
Dr Raelia Lew:
Caroline, you and I go back quite a long time. We went to school together. We subsequently went to medical school together. We’ve even lived together on rotation at Mildura Hospital and also in the context of being junior doctors. So we go back a really long time, and I am really excited to have you on Knocked Up to talk about your most recent development, which is the app, Cycle Guide.
Before we get to Cycle Guide, how did your life experience bring you to think about developing an app for patients going through IVF?
Dr Caroline Fiddler:
I’ve been through IVF and I was most fortunate to be successful and have a lovely baby daughter now. I did find the experience quite challenging — coordinating appointments, making sure everything was as organised as possible. I had a very supportive team, but at the end of the day, it's still up to you as the patient to do the injections as required, to take the medication as you’re meant to, to prepare for procedures — all while feeling anxious about whether you’ll have a successful outcome.
So really, organising the logistics of treatment only adds to the anxiety you’ve already got in the background. As a doctor, I’m experienced with trying to make processes for patients smoother. That experience helped me try and work out a better way to take a bit of pressure off the patient and let them manage their own cycles as well as possible.
Dr Raelia Lew:
One of the really great things I like about the app you’ve developed — Cycle Guide — is that it can be used by any patient having treatment. It’s not necessarily affiliated with any computer program external to the app or any IVF unit where patients may be undertaking treatment under the care of their specialist. It’s an adjunct to their care, a technology to help track their progress in their cycle. Tell me why you designed Cycle Guide in this way.
Dr Caroline Fiddler:
Great question, Raelia, and thanks for knowing so much about it. You’re right — it’s not affiliated with any particular clinical doctor. So it really empowers the patient to support their own treatment instructions and their own process. You can feel more in control, more organised, and have some peace of mind.
What I wanted was portable treatment instructions that you could carry around with you and get reminders throughout the day. You can also use it when nurses call you with really important treatment instructions. I remember being called at all times of the day — it was quite an awkward situation. You might be writing on the back of your hand or Post-it notes with important instructions. So this way, you’ve got it with you wherever you go.
And it’s also, as you said, in your own words and flexible. It can be used by anyone. It’s nice and simple. It doesn’t assume that you’ve got any healthcare training or that you’ve ever done injections before. It also doesn’t give medical treatment instructions — it’s really just to support you alongside your treatment team. It doesn’t seek to replace it; it just seeks to support you in putting in your own information. And by doing that, it reinforces what you’re doing so you feel more in control in a situation that can already be very stressful and distracting.
Dr Raelia Lew:
And Caroline, Cycle Guide — one of the nice features that I liked, and that I just remembered when you spoke to me about it — I reflected on my own experience, both as a doctor and as a patient. You mentioned that there’s a way you can track what medications you’ve already administered. You can note that it has been administered. I think you gave the example of waking up in a cold sweat — “Did I take my medication? Did I not?” — just having a lapse of memory, disoriented, if you're taking them at night at the end of a busy day. And you gave that visual of checking the sharps container — how many needles were in there — to kind of deduce whether you’d actually given the dose of antagonist that particular day. Was that based on a real personal experience?
Dr Caroline Fiddler:
It was. I even remember that I had some needles left over from before, some syringes, so I couldn’t even work out how many… you know, it wasn’t even a full box that I was working from. So I thought, “Oh no. I can’t even work it out that way.”
Absolutely, I needed some peace of mind that I’d given it — just something to tick off and say it’s done. When I come back later, I think probably in my gut I knew I’d given it, but just that anxiety about the gravity of the situation. And if I didn’t have a successful cycle, I might reflect and think, “Oh gosh, I didn’t give that injection. Did that cause me not to be successful?”
So absolutely, it was just something that I could do that was tangible, that was practical. I’d ticked it off — I’d done it.
One of the nice features of the app is having a whole month laid out. So you can see for the month whether you’ve got work commitments, holiday commitments, shift work, other functions where you might need to take your freezer bag with you. You can just plan ahead.
At the bottom below that, it has your task list. So as you’ve said, Raelia, you can tick off — and it does say the number of tasks for that day. They’re in chronological order. If you’ve accidentally ticked the wrong thing, you can untick it. So there’s no problem there. You can go back and undo that, and you can always check before and after that day what you’ve done. So it makes it nice and clear.
Another feature is that we’ve got “Day One,” and then everything after Day One is then sequentially numbered. So you’ve got both the date and the day. You can feel confident that you’ve got both types of information to be as certain as possible that you’re doing the right thing at the right time.
Dr Raelia Lew:
That’s right. And for any patients who are doing a start of a cycle that isn’t with a “day one” — like a planned start or a random start or a pill start from a cycle where day one is defined as the first day of your menstrual period — it can be day one of the cycle as opposed to day one of the period. So it’s flexible in that way.
Dr Caroline Fiddler:
Yes, you’re right. You can still use the app in that way, whether you put in day one or you omit it — whatever your treatment team thinks is the easiest thing to do.
Dr Raelia Lew:
You mentioned that medications are not the same, obviously, and are not preselected — that we enter them in our own words using Cycle Guide. You can describe medications in a way that is meaningful to you and in the way that you’ll remember them, as opposed to a drug name or a generic name, which can be quite confusing. And of course, IVF cycles have a lot of variants in the different medications that are chosen to suit the medical issues and background characteristics of individual patients. So that’s really, really quite good. What led you to design the app in that way?
Dr Caroline Fiddler:
I worked with Appetiser Apps, and we really tried to thrash out a very simple approach — making it both simple for the medication and simple for the type of cycle or procedure. Given that the principles of each cycle have some overlap — although they have a lot of variation, as you said, Raelia, and can be quite complex — by keeping the app nice and simple and flexible, that makes things a lot easier.
I noticed that in some other apps, you’ve got long lists of medications that people can choose from. And although that’s great, as you said, everything’s evolving. Medication names can change, preferences of the doctors change, new ones are developed. So that’s one thing — and you might accidentally click on the wrong one, given that sometimes these lists are quite long.
So I thought, in the theme of keeping things simple, you could type in however you wanted to think of it. Sometimes I thought of the trigger as the aqua pen, as opposed to, say, the burgundy pen. That doesn’t take away from the fact that you’ve got an actual name of the medication to use from your treating team. It’s just another way to prompt you to remember.
You can still put in the drug name, the trade name, generic name — whatever you like. It’s just that you’ve got some choice about how you describe it. And sometimes by typing it in, it helps you remember, because the boxes the medications come in often have a lot of different names. It can be a little bit overwhelming — a lot of long words. So just choosing the thing that helps you remember, I thought that was important. And it made it as flexible as possible for every cycle, every patient, every doctor, every team.
Dr Raelia Lew:
And Caroline, have you had feedback from patients using the app that has given you insights that you might not have thought of yourself?
Dr Caroline Fiddler:
I’ve had some excellent supportive feedback from nurses, who are integral to patient treatment — I know that from personal experience. They are coordinating the treatment throughout, calling you throughout. It’s very important information. So they had very supportive feedback when they used it.
They liked that it was simple. They liked the calendar. They liked the task list. They liked the flexibility. And one thing they really liked was the task list.
Under the initial screens — “What do you want to add to your calendar?” — it has all the basics of IVF. So it has day one, ultrasound, blood test, medication, procedure, appointments. Keeping it nice and simple but also purpose-built.
To quote one of these nurses, she said, “If I was going to design an app, this is how I would design it.” And I can’t think of a better support for the app. I was thrilled to hear that.
Dr Raelia Lew:
Yeah, that’s amazing feedback. And I’ve shown my nurses the app Cycle Guide as well and asked that they offer it to all our patients, because I really like it, and I think it’s a great tool that can just take some of the stress out of the patient-managed side of IVF.
Because with IVF — I always say it takes 25 people to make an IVF baby. When you take into account the doctor — I kind of think of myself as the captain of the ship — but we also have other important stakeholders and leaders and participants in the IVF journey.
Obviously, the biggest stakeholder is the patient, but we also have our nursing team, our counselling team, our administrative support team. IVF is, after all, about coordinating sequences of events and appointments over a long-term timeline.
It’s not like booking one operation, as we often do in different areas of gynaecological surgery. It’s a series of appointments. You design a treatment, then you have to educate about the treatment, and then you need to implement and orchestrate the various aspects of the treatment.
One of the most important people — obviously, the most important person — in the treatment is the patient. But there is a patient-led and a patient-performed aspect of treatment. In fact, it’s quite a big aspect of treatment, and that is the enactment and delivery of the medications at the appropriate stages.
Quite unlike what most people have gone through when seeking medical treatment for other conditions, it is more like an orchestra, I suppose, of medications — not a solo performer. It’s not like when you have a thyroid problem and you take a thyroid tablet, or if you have a skin problem and you put on a skin solution.
It is a series of different medications — some used in an overlapping fashion at the same time, and others used at different stages of the cycle. The timing is not that you can just take it at any time of the day, and if you forget it, you just take it later. So, you know, it is complicated.
And I would think that up to that point in a person’s life — given that most IVF patients are relatively young and healthy — it is probably the most complex medical endeavour that they’ve ever had to go through.
Dr Caroline Fiddler:
I think that’s absolutely spot on, Raelia. And I think you’ve touched on the fact that people tend to be in the slightly younger age group when they’re having IVF, and they may not have ever done a self-injection — unless maybe they’re diabetic or have had other issues — but often it’s the first time you’ve done a self-injection.
And the first time you’ve coordinated all different medications, whether they’re tablets, pessaries — all different types. And as you said, they’re at different times and fairly time-sensitive.
So there’s a fair burden of responsibility on the patient, irrespective of how wonderfully supportive the treatment team is. At the end of the day, it’s still on you to do things in the right way, at the right dose, in the right manner, at the right time.
It can be quite overwhelming. So anything you can do to reduce that anxiety, to coordinate things better, I think is more than worthwhile.
Dr Raelia Lew:
Caroline, are you able to tell us — we know that Cycle Guide is for IVF — but what specific types of treatments can Cycle Guide support patients with?
Dr Caroline Fiddler:
One of the important parts of Cycle Guide was keeping it flexible and simple and useful. Rather than having to choose the type of cycle you’re doing right at the start, it’s generic and open. So it can be used for all types.
We’ve got a category called “procedure” — all different types of procedures or cycle types. So you can have it for egg collection, embryo transfer, intrauterine insemination.
And we’ve also got an “other” category — so that’s for any other types of procedures or cycles you might need to do. Given that the principles of each cycle tend to be: day one, ultrasound, blood test, medication, procedure, and appointments — that really covers all types of cycles. So it’s nice and flexible.
Dr Raelia Lew:
That’s great. So I would think the “other” category, for example, might be useful for ovulation induction cycles, where people have natural intercourse to conceive after a series of medications to induce and track ovulation.
And it could also be used by male IVF patients who are having something like a testicular sperm retrieval procedure — or who are donors and perhaps have various blood tests and appointments to attend, and sperm sample drop-offs to the lab for their treatment as well.
Dr Caroline Fiddler:
Absolutely. It could be used for any number of things, as you’ve said.
Dr Raelia Lew:
In terms of finding the app — if this resonates with our listeners and they wanted to find Cycle Guide — how would they find it?
Dr Caroline Fiddler:
It is available in the App Store now — either directly through the App Store or through my website: cycleguide.com.au. In the App Store, you can either search for “Cycle Guide” (one word or two), or you can Google “IVF” and it will come up fairly high in the search terms as well.
Jordi Morrison:
Would you recommend for someone who hasn’t yet started treatment but might be learning or starting the doctor’s appointments — is it good for them to get used to the app before they begin a treatment?
Dr Caroline Fiddler:
Good in a couple of ways. One of the features we’ve got is the pre-cycle checklist. I found that heading up to day one, sometimes you’re not quite sure when you’re going to have a day one — when your menstruation is going to be heavy enough to call it “day one” as defined by your clinic. So it was good to be organised before a slightly uncertain date.
And you’re already a little bit apprehensive given the enormity of what you’re about to do. In particular because pharmacies that stock IVF medications aren’t always open all the time — you can’t just always duck to your 24-hour pharmacy. You’ve got to have that medication beforehand.
I found it reassuring to have watched some videos from the clinic I was associated with — to understand how to give the injections, how to store them, what my work roster might look like, where I might be travelling, what shifts. So I had a good idea of what things would look like before I started to bleed. I felt really reassured that I had done everything I could to be certain.
The other part of being prepared is that — as you said, Jordi — you can have a look at the app and get a good feel for it. You could put in a mock cycle and then there’s a function to delete all data. So just have a go, see what it looks like, feel comfortable with how it works and all the different functions.
As much as you’re ready for day one practically, you’ve also got the portable Cycle Guide app there to help you — and you understand it well.
Dr Raelia Lew:
And for any of my patients at Women’s Health Melbourne and Life Fertility Clinic Melbourne having treatment under my care for IVF or assisted reproductive treatments like egg freezing, IUI, or ovulation induction — I have actually shown Caroline’s app and details to all of our nursing team, and it would be their pleasure to assist you if you’d like to use it in entering that initial data. So do reach out to the team.
Taking it on a tangent away from the Cycle Guide app — obviously this app has been developed because you had the insight as a doctor and a patient going through treatment in an age where technology has become our best friend in many ways. You noticed that most IVF patients hadn’t necessarily taken up that technology to assist them in a way that it potentially could benefit them.
What other things have you noticed that we may not be focusing on in IVF from a clinical perspective that might improve a patient’s experience, from a doctor’s perspective?
Dr Caroline Fiddler:
When you’re on both sides, it’s certainly an interesting insight — because you’re looking at one side and reflecting on the other. I thought everyone did everything that they could. I thought the thing that could have been a bit better might have been having more access to psychological support.
There was mandatory counselling, which was excellent, but I would have liked a little bit easier access to that — slightly more open hours to speak with the nurses if I needed to. That would have been more helpful.
Those were probably the main things. I think it’s inherent that you probably have to be able to take a phone call at any time, but sometimes it was a little awkward if I was on the ward having to give my three points of ID before I was able to be given important information. I learned to say my name, date of birth, and address very quickly — but that was also a bit awkward. Probably a necessary part of the process, but if there’s any way to make that a little smoother, that would be helpful.
I loved that I was able to speak to the embryologists. I thought that was wonderful — to speak to someone in the lab. The nurses were very supportive. I also found the psychologists very helpful, and they’re often able to reflect on what other people have done in similar situations — or even different situations — or even projecting into the future. So I found those counselling sessions tremendously helpful.
Dr Raelia Lew:
We have actually a past episode of Knocked Up, which we can also link to in the show notes, with Suellen Peake, who’s our head of counselling at our unit. I think she offers a remarkable service to our patients.
I think a lot of IVF patients, particularly when they’re starting out, see mandatory counselling as a bit of a “naughty corner must-do” activity rather than something of personal benefit. But I think that the vast majority of patients who walk out of Suellen’s office have really benefited greatly and have a new appreciation of how much the counselling can help.
So I think that’s a really important insight as a doctor. Because I think as a doctor, we often say, “Oh no, we’ll be right. We don’t need this, we don’t need that.” And it’s sometimes really important to surrender to being a patient — and not try to be the doctor and the patient — because that’s a burden you just don’t need to carry as a patient.
How did you kind of straddle that doctor-as-a-patient phenomenon?
Dr Caroline Fiddler:
Yeah, it’s an interesting one. I think sometimes people might assume you know more than you do, and you just think, “Just treat me like everyone else.” Because IVF is a specialised area, and you certainly don’t want to assume anything. It’s certainly not something you can learn overnight. Obviously, you’ve taken your training even further, Raelia, having such a high qualification.
I think it was also making sure I just said, “Treat me as though I don’t know much, so I can know as much as possible.” I suppose I was really a sponge because I — like all patients — so wanted a good outcome.
I spoke with multiple psychologists, so it was great to see different people’s approaches. I think it helped me guide some of the decisions that I made. Obviously, it was in combination with the treating team, but it certainly gave me a different perspective — a bit broader.
I happened to change fertility specialists, and I think that really helped lead to having a lovely daughter. We’ll never know, but I think just stepping back and thinking about the bigger picture — and thinking about examples — there’s so much unknown in IVF. There’s a bit of luck, a lot of science, and it’s hard because there’s so much uncertainty. So I think the psychologists really helped with that.
It sounds like Women’s Health Melbourne has covered that — and then some. I think that’s a really, really important part. So that’s really encouraging to hear.
Dr Raelia Lew:
Yeah, we definitely need the science, the art, and the magic to make an IVF baby. You need all three.
Jordi Morrison:
Thank you so much, Caroline. We’ll put a link to the app in the show notes as well.
To support Knocked Up, leave us a review or recommend to a friend. Join us on Instagram at @knockeduppodcast and join Raelia at @doctorraelialew, and email us your questions to podcast@womenshealthmelbourne.com.au.