Which IVF Protocol is Right for You?

In an era of personalized medicine, there are several protocols that can be used to stimulate the ovaries of in vitro fertilization (IVF) patients. With each, the goal is to retrieve the optimal number of eggs required to obtain enough healthy embryos to result in at least one pregnancy.

Each type of IVF protocol, whether it’s a traditional protocol or an alternative protocol, has its own process and is best for different types of patients. Learn more and talk to your fertility doctor to decide what’s best for you.

Traditional IVF Protocols

Antagonist Protocol or Short Protocol:

This is the most commonly used IVF protocol. It involves the fewest number of injections and is effective for the majority of patients.

  • You may be instructed to use birth control pills prior to starting an IVF cycle.
  • For 10 days, you’ll take follicle-stimulating hormone (FSH) and lutenizing hormone (LH) injections. Starting around the fifth day, the Gonadotropin-Releasing Hormone (GnRH) antagonist is added to prevent premature ovulation.
  • Your doctor may use a “Lupron trigger” or “dual trigger” to stimulate the final maturation of the oocytes prior to retrieval and significantly decrease the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Lupron Down Regulation, or Long Lupron Protocol:

This protocol may be used in younger patients or in patients who have poor embryo quality from other protocols.

  • You may be instructed to use birth control pills before you start an IVF cycle.
  • By week three, your doctor will administer an injectable medication called Lupron.
  • When given before as part of the “long protocol,” Lupron temporarily stops the pituitary gland in the brain from secreting FSH and LH. This allows the FSH and LH from the injectables to control your cycle and prevents premature ovulation of the follicles.

The Flare Protocol or Microdose Lupron Co-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 FSH.

  • You’ll continue to take the microdose of Lupron during the stimulation phase up until the Human Chorionic Gonadotropin (hCG) trigger injection.
  • By adding “internal production” of FSH to the “external FSH” being administered as fertility medications, this protocol often results in enhanced responsiveness of the ovaries and an increased number of oocytes retrieved.

Alternative IVF Protocols

Estrogen Priming Protocol:

In some women who respond poorly to the short protocol (e.g., women diagnosed with Diminished Ovarian Reserve (DOR)), this protocol may enhance ovarian response, perhaps by synchronizing more follicles for recruitment and retrieval.

– In conjunction with the Antagonist/Short Protocol, your fertility doctor may advise you to administer an estrogen patch, and possibly a few days of GnRH antagonist, even before day 1 of a cycle.

Mini-IVF or Micro-IVF Protocol:

As an alternative to traditional treatment, there are some programs that believe that “minimal” stimulation may provide advantages.

Your doctor may advise using fertility pills, such as Clomid, or very low dosage medications, so that they can retrieve one or two eggs at a time.

The disadvantage is that it produces very few chromosomally normal eggs, and it takes many more egg retrievals to achieve a pregnancy.

Ultimately, the best protocol for each patient should be neither “maximal” nor “minimal,” but instead, be “optimal,” and based on the patient’s age, Anti-Mullerian Hormone (AMH) levels, basal follicle count, medical history, and family building goals.

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

 

Dr. Alan Copperman is a board-certified reproductive endocrinologist and infertility specialist with a long history of success in treating infertility and applying fertility preservation technologies. He serves as Medical Director of Progyny, a leading fertility benefits management company, and co-founded and serves as Medical Director of RMA of New York, one of the largest and most prestigious IVF centers in the country.  Dr. Copperman is also the Vice Chairman and Director of Infertility for the Icahn School of Medicine at Mount Sinai, and Chief Medical Officer of Sema4, a health information company. Dr. Copperman has been named to New York magazine’s list of Best Doctors 17 years in a row. He has been recognized by his peers and patient advocacy organizations for his commitment to patient-focused and data-driven care. He has published more than 100 original manuscripts and book chapters on reproductive medicine and has co-authored over 300 scientific abstracts on infertility, in vitro fertilization, egg freezing, ovum donation, and reproductive genetics.