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Which IVF Protocol is Right for You?

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There are three main protocols that are recommended for in vitro fertilization (IVF) patients. However, each patient responds differently to the cycle and some may benefit from alternative protocols or additional treatments for greater ovarian response, increased number of eggs retrieved, and better quality embryos.

Traditional IVF Protocols

Lupron Down Regulation, or Long Lupron Protocol: Your fertility doctor might prescribe birth control pills to get rid of any lingering ovarian cysts and create a clean hormonal slate for the IVF cycle to begin. Just as you are finishing the birth control pills, you will then be instructed to take Lupron injections, overlapping with stimulation fertility drugs, until the time of hCG trigger injection. The Lupron will turn off your body’s natural hormone production so as not to interfere with the stimulation drugs. Within 48 hours of hCG trigger, your eggs will be retrieved, fertilized, and transferred back into your uterus. The entire cycle takes approximately 2 months from start of birth control until pregnancy test.

Antagonist Protocol: If you’ve experienced an unfavorable response to the Lupron Down Regulation or are at risk of Ovarian Hyperstimulation Syndrome (OHSS) as in Polycystic Ovarian Syndrome (PCOS), your fertility doctor might advise an Antagonist cycle. Again, you may be prescribed birth control pills to silence your hormone production. You will be instructed to take stimulation drugs and after approximately 5 days, you will begin the antagonist drug for only a few days until you are ready for hCG trigger injection. Your eggs will be retrieved, fertilized, and transferred into your uterus. This cycle takes approximately 2 months from start of birth control until pregnancy test.

Agonist Protocol or Microdose Lupron Flare Protocol: If you have had a poor response to other protocols or are of advanced maternal age, your fertility doctor might recommend a lower dose of Lupron that stimulates (rather than suppresses) the body’s natural production of follicle stimulating hormone (FSH). This is considered the “flare” period. You will continue to take the microdose of Lupron during the stimulation phase up until hCG trigger injection. The combination of low-dose Lupron and stimulation drugs maximizes the patient’s ovarian stimulation potential. Your eggs will be retrieved, fertilized, and transferred back into your uterus. This cycle takes approximately 6 weeks, if birth control is not used, until the time of pregnancy test.

Alternative IVF Protocols

Estrogen Priming Protocol: In conjunction with the Antagonist Protocol, your fertility doctor advise you to use an estrogen supplement to silence natural hormone production and ovarian stimulation. The estrogen patch is typically prescribed two weeks before day 1 of your cycle and is replaced daily until your period (cycle day 1) arrives. The stimulation period begins and follows the Antagonist protocol. This is best for poor responders or women diagnosed with Diminished Ovarian Reserve (DOR).

Mini-IVF or Micro-IVF Protocol: This protocol is similar to traditional IVF, however, less fertility drugs are used during the stimulation phase. Unlike traditional IVF which aims to produce the maximum number of follicles, the goal of mini-IVF is to produce two, high quality embryos. The cycle may begin with use of birth control pills through to the next cycle. On cycle day 3, the stimulation phase begins, using a small dose of injectable fertility drugs in combination with Clomid until the time of hCG trigger injection. Eggs are retrieved, fertilized, and transferred back into the uterus. This protocol is recommended for patients without a complicated fertility disease and for women of advanced maternal age or poor responders.

Contact your fertility doctor for information on additional protocols and to find out which protocol is right for you.

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