What are the different stimulation protocols for IVF?

About the different stimulation protocols for IVF, it is a matter of selecting right one for our patients. When we have a woman with a good ovarian reserve we can go with a mild stimulation protocol which includes not using so many hormones during the IVF protocols. If we have a low ovarian reserve woman, we must use a larger dose during the IVF protocol to get the best out of the ovarian reserve we have left. When we have extremely low ovarian reserve, we have IVF protocols that include different types of medication such as hMG which is a mix between FSH and LH. In low doses, added with letrozole it is a pill that our patient can take. Those are protocols designed for low ovarian reserves so we can get some good quality eggs from the ovaries. Of course there are a lot of different types of protocols, the upstate or up regulated protocols in which we will begin with a low dose and then increase, but you can also do it the other way around with a big dose and then begin reducing. The most important part of this question is that we must adjust the protocol to the patient in front of us. This is the most important thing to consider when we decide the program an IVF protocol.

We have a lot of different protocols for stimulation. From the historical point of view, protocols of stimulation started a lot of years ago with natural cycle then, it was a stimulation with medication like clomid, like urinary gonadotrophins and in the 80s it was discovered that using the agonist gonadotropins releasing hormone prevent premature ovarian ovulation and the era of “long agonist protocol” started from this moment and during last 20 years it was the dominant protocol of stimulation. It is very common, very useful because you can plan your egg retrieval, you can plan when your patient come because you can move the beginning of stimulation in this protocol but the main problem of long agonist protocol that only one possibility to produce the final egg maturation – this is the injection of HCG chorionic gonadotropin and this medication may provoke ovarian hyperstimulation syndrome – this was the main reason why this protocol was changed and nowadays we switched to short antagonist protocols – it means that we stimulate ovary and at the end of stimulation add medication which prevent LH activity, antagonists of gonadotropin releasing hormones and now most of protocols all over the world it is short, antagonist protocols.

Also we are still using protocols with clomid with anti-estrogen like letrozole mostly for patients with poor ovarian reserve because if we have low number of eggs whatever stimulation we will do, we will receive one egg. In this case, it is better to not spend a lot of money and use a lot of medication. We can also start stimulation from the second phase of the cycle, from the middle of the follicular phase just after ovulation, also we can do two stimulation in one cycle. So, different kinds of protocols nowadays we can use. The main idea on how to choose one or another protocol is to adapt to ovarian reserve and understand in which protocol, we will be able to receive more eggs or better quality eggs and for each patient it is necessary to review their case.

Within assistant reproduction treatment we have different protocols such as long protocols, short protocols, protocols with antagonists or double stimulation. How do these protocols differ from each other? Well each protocol differs with each type of patient in terms of use of medication and the dose as well.

There’s a huge variety of stimulation protocols and this is continually modified all the time. Often what you’ll hear about is long and short protocols which are two different types and the commonest types that we use. The long protocols are using GnRH agonists to control pituitary function and then short protocols are GnRH antagonists based to use that. There’s advantages and disadvantages for both of those approaches. Overall success rates are similar and which is why they’re very commonly used. You will hear about other strategies like flare-based protocols, dual stimulation, mild IVF – all these different strategies can be used. The key is the clinician that you’re working with, individualizes things for you and your circumstances.

There are 2 main protocols for the recipients, long and short protocol. The short one is used more frequently. From the 1st, 2nd, or 3rd day of your menstrual bleeding, you will start taking estrogen pills to improve your uterus, inner lining endometrium to prepare it for embryo implantation.

Depending on the embryo’s age, whether it is a 3-day or 5-6 day embryo, you’ll also be taking progesterone pills for the same amount of time, so 3-5 days. You’re going to take estrogen pills and progesterone. Your gynaecologist will measure the uterine inner lining to make sure it is thick and good enough for embryo transfer and embryo implantation.