Treatment protocols are the method of which the fertility specialists take control of the hormones to ensure the best outcome. These protocols vary depending on circumstances.
There are multiple IVF treatment protocols.
Traditionally the long protocol is used where the regulatory gland which is known as the pituitary gland is suppressed. This takes approximately 3 weeks of injections before the process of stimulation starts. It is called a long protocol because it takes an additional three weeks of injections before we start the process of stimulation.
This ensures that your own hormones do not interfere with the action of the subsequent hormone injections which are designed to stimulate egg growth. It is given as daily injections and usually starts on day 21 of your cycle.
The medicine stops the ovaries from working temporarily. This phase can be mildly uncomfortable but lasts for just a 2-3 week period and the majority of patients cope well. A scan after 2-3 weeks confirms that the signal switch-off has happened, though in a few cases it may take longer.
This medication is not a contraceptive and we advise that you use condoms to avoid a pregnancy during this suppressive period.
The antagonist treatment protocol is a slightly different IVF protocol. It is a shorter protocol and rather than suppressing the pituitary gland over three weeks, the gland is blocked. This antagonist protocol starts on day four or day five of stimulation of the ovaries. In many clinics, the antagonist protocol is now the preferred protocol. The advantage of the antagonist protocol is that it can lower the risk of overstimulation and has the ability to use a dual trigger.
These medications block the ovary from releasing the eggs before they are due for collection. They are administered by injection around the 5th or 6th day of hormonal stimulation, after a scan and a blood test.
This treatment is usually used in cases of PCO (polycystic ovaries) where it reduces the chances of an overresponse. It can sometimes be used for your convenience and in the cases of some older women. It is rarely ineffective in blocking natural ovulation from occurring (1-2% when ovulation occurs before egg collection).
The difference between the long the short protocol is the time duration. The long protocol takes an additional three weeks of injections before the process of stimulation of the ovaries.
In some cases, the contraceptive pill is used in the antagonist protocol. The aim of the contraceptive pill is to programme the treatment cycle and planned start on the appropriate date, and it can also help in synchronising follicles. The contraceptive pill is given either on day 21, which is called luteal phase pre-treatment or in the follicle phase where it’s called follicular phase pre-treatment.
In some cases, the oestrogen pill is used in the antagonist protocol. The aim of the oestrogen pill is to programme the treatment cycle and planned start on the appropriate date and in addition it can also help in synchronising follicles.
The oestrogen pill is given either on day 21 visits callers luteal phase pre-treatment or in the follicle phase where it’s called follicular phase pre-treatment.
Steroid treatments can be used to suppress the high hormones in polycystic ovaries or in some cases recurrent implantation failure. Generally, this has been abandoned and is rarely used in the treatment.
The flare protocol is a protocol where the gnrh analogue which is also used for down-regulation is used though only for the first five to six days of the period. The aim is to create a flare of hormones mainly of FSH and LH as soon as these analogue injections start. The aim of this is also to recruit more follicles by using nature’s mechanism of pushing the ovary to create more eggs. This can further be continued till the day of the trigger where it becomes the shot agonist protocol
Many patients ask, “which IVF protocol is best?”. At Fertility Plus we aim to use the most appropriate treatment cycle according to the needs of the patient. Around 95% of our treatments are in the antagonist protocol. This helps us to lower the risk of overstimulation syndrome and also in cases of poor responders allows us to use a dual trigger which may help to improve the quality of the eggs.
For more information on IVF or ICSI treatment, please download our IVF leaflet here.