Before the egg retrieval, ovarian stimulation has to occur. Under normal circumstances and flow, female body produces a single mature egg per menstrual cycle — only one egg per month.
In IVF, higher the amount of retrieved eggs, higher the number of embryos. Accordingly, higher will be the chances of success. For that reason, the aim of the ovarian stimulation is to energize ovaries in order to make more follicles and quality eggs.
This is exactly when different protocols come in. There are several ways to stimulate ovaries and deciding upon one of them, depends on various medical factors.
Further we will discuss the most common and traditional stimulation protocols:
Lupron Down Regulation
On the first cycle, lupron down regulation is the most commonly used stimulation protocol. It may also be referred to as “lupron overlap protocol”.
First of all, birth control pills may be prescribed. They are used to create a clean hormonal state for the IVF cycle to begin. Birth control pills are taken for about 3-4 weeks. During the final period of the intake, lupron injections will begin. Lupron helps to prevent body’s natural hormone production, so that they do not interfere with the effect of stimulation drugs.
Few days after the patient stops to take birth control pills, FSH (follicle stimulating hormone) will enter the process and help the development of the eggs. When the follicles are mature enough, hCG (human chorionic gonadotropin) will be injected and help the eggs to mature. After the hCG, eggs will be retrieved in a period of 36 hours.
Antagonist protocol will usually be used if the lupron down regulation did not give favorable results and the patient did not respond to it. Antagonist protocol will also be needed if there is a risk of Ovarian Hyper stimulation Syndrome.
The process will start with the birth control pills. After about 5 days, the stimulation drugs will be taken. Unlike the situation with lupron where 4-5 weeks of injection may be needed, antagonists do their suppressing job much quicker, with the approximate total period of 4-5 days.
The protocol is finalized with the hCG trigger injection, followed by the egg retrieval.
As already mentioned, chances of the ovarian hyper stimulation syndrome are decreased during the antagonist protocol.
Micro dose Flare Protocol
When patient’s response to the above mentioned protocols is poor, doctor may suggest micro dose flare protocol. It is also recommended when maternal age is above the certain number and ovarian reserve is low.
Micro dose flare protocol is also known as ”low dose lupron protocol” or “poor responder protocol”.
In this case, lupron is taken but in the significantly lower doses. However, the intake frequency is increased up to two times a day. Unlike other protocols, low dosage of lupron will not suppress, but stimulate body’s natural hormone production. This will result in the increased release of FSH(follicle stimulating hormone). The micro dose lupron intake will be followed with the hCG trigger injection and egg retrieval.
This protocol tends to maximize ovarian stimulation potential of the patient. That’s why it is used when the patients has the poor response.
As you may have already noticed, protocols may be divided according to patient’s response to the ovarian stimulation. With this in mind, we can estimate that patients with the high response will be prescribed the lupron down protocol, intermediate responders — antagonist protocol and poor responders — micro dose flare protocol.
Ovarian stimulation protocols are indeed complex. They are chosen through the individual approach, after the doctor studies patient’s medical history. If the stimulation was already performed once, based on the previous IVF cycle results, different protocol may be chosen in order to maximize the fertilization rate.