Down Regulation Protocol
This is also known as the “Long Protocol” and is the commonest one used for IVF treatment.
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 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 contraceptive and we advise that you use condoms to avoid a pregnancy during this suppressive period.
This is also known as the antagonist protocol and is relatively short in duration. It can be used with the pre-treatment of pill or oestrogen tablets (also known as oestrogen priming) or with the start of the period.
These medications block the ovary from releasing the eggs before they are due for collection. They are administered by an 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 over response. 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).
As part of the IVF treatment, we may recommend the pill prior to starting the IVF stimulation. Controversial as it may seem, a 3 to 4 week treatment with the pill can sometimes help to prepare the ovaries and improve results.
In some cases, we may give oestrogen tablets to prepare the lining of the womb before the IVF or ICSI treatment commences. This may help women who have had a poor response in a previous treatment cycle or had repeated IVF failures.
In cases where the lining of the womb is thin we may advise 3-4 months of oestrogen priming before IVF.
We may use a small dose of steroid during your IVF treatment cycle, with an agreed protocol, either to improve response or to help lower the natural killer cells (NK) after embryo transfer.
We may advise you to have immune blood testing prior to treatment.
The flare protocol combines the injection used for down regulation for a very short period of 3 to 5 days starting day 1-3 of your cycle.
This enables a flare of FSH from the pituitary gland and may enhance the action of the stimulating drugs in some women.
For more information on IVF or ICSI treatment, please download our IVF leaflet here.