{"id":75055,"date":"2017-02-07T00:00:00","date_gmt":"2017-02-07T00:00:00","guid":{"rendered":"https:\/\/www.fertilitysmarts.com\/2017\/02\/07\/ivf-stimulation-protocols"},"modified":"2023-11-08T19:40:20","modified_gmt":"2023-11-08T19:40:20","slug":"ivf-stimulation-protocols","status":"publish","type":"post","link":"https:\/\/www.fertilitysmarts.com\/types-of-ivf-stimulation-protocols\/2\/1327","title":{"rendered":"IVF Stimulation Protocols"},"content":{"rendered":"

During an in vitro fertilization (IVF)<\/a> cycle, doctors use medications to calibrate a woman’s menstrual cycle in a way that allows more control over the outcome of the procedure. These injections are part of the protocol needed to prepare the body for treatment.<\/p>\n

Here we cover what stimulation protocols are, why they are used, and we dive into a few variations of protocols that may be used.<\/p>\n

Why are stimulation protocols used for IVF?<\/h2>\n

The most critical aspect of the IVF process is to have good-quality embryos to transfer back to a uterus. Because a dramatic reduction in the number of viable eggs and\/or embryos from the time of the egg retrieval to an eventual embryo transfer is a common occurrence, a larger number of eggs is beneficial in an IVF cycle.<\/p>\n

In a typical menstrual cycle, most women produce multiple egg follicles, but only one follicle will become dominant and mature into an egg that is released through the process of ovulation. IVF stimulation protocols use medications to stimulate a woman’s ovaries in a process known as ovarian stimulation, which causes the production of multiple follicles at once. <\/span><\/p>\n

Logically, more follicles should translate to more eggs, which should translate to more embryos, which hopefully translates to high-quality embryos for transfer, which means better odds for achieving pregnancy.<\/span><\/span><\/p>\n

Variation in Stimulation Protocols<\/h2>\n

There are different ways medications are used to stimulate the ovaries during an IVF cycle and these are called IVF protocols. When you hear about injections of medication for IVF, a protocol is generally what is being referred to. Protocols differ depending on personal circumstances that can include a specific diagnosis or age.<\/p>\n

The following are examples of three common protocols. These are examples only. Always adhere to your own doctor\u2019s instructions for your cycle.<\/p>\n

Long Lupron (Overlap) Protocol for IVF<\/h3>\n

Lupron (also known as leuprolide), is a medication that acts to temporarily overstimulate the body’s production of fertility hormones, but afterward causes the body to temporarily stop producing these hormones. Lupron ultimately blocks the pathway between the ovaries and the control centers in the brain, giving the doctors more control over the treatment cycle.<\/p>\n

Birth Control Pills to Regulate Hormones<\/strong><\/p>\n

This protocol \u2014 also called standard or overlap protocol \u2014 usually starts with birth control pills, which are used to regulate the body\u2019s hormones and synchronize the timing of the other drugs.<\/p>\n

Another advantage of using birth control pills to overlap the Lupron is that the pills suppress the formation of ovarian cysts<\/a> that sometimes form when Lupron is taken.<\/p>\n

Lupron Starts<\/strong><\/p>\n

On Day 21 of your cycle (or after 21 days of active pills) you begin taking Lupron. This drug acts on the parts of the brain that communicate with the ovaries. The body\u2019s initial response to Lupron is to produce a surge of hormones that stimulate the ovaries. This is followed by suppression of the ovary with continuing Lupron.<\/p>\n

Have hormones been sufficiently suppressed?<\/strong><\/p>\n

It takes around 10 days of Lupron to fully reduce the body\u2019s natural hormones to a very low level. When the hormone levels are sufficiently low, you are said to be suppressed or down-regulated. This suppression helps to synchronize the follicles so that hopefully more are available to respond to the stimulation injections.<\/p>\n

Stimulation Phase<\/strong><\/p>\n

The birth control pill is eventually discontinued and Lupron continues during the stimulation phase of the cycle. This phase involves the injection of follicle-stimulating hormone (FSH)<\/a> and luteinizing hormone (LH) fertility drugs that stimulate the follicles to grow in the ovaries. During this time, you have various ultrasounds and blood tests to monitor the developing follicles, and the dose of drugs can be altered accordingly.<\/p>\n

Because the growing follicles produce and secrete estrogen into the bloodstream, the circulating levels of estrogen are monitored closely during the stimulation phase. This level, coupled with ultrasound counts and measurements of the follicles, allows the doctors to accurately measure the body\u2019s response to the drugs.<\/p>\n

Trigger Shot to Mature Eggs<\/strong><\/p>\n

After approximately 10 days of stimulation, when the biggest follicles are around 18 to 22 millimeters (about 2\/3 to 5\/6 inch) in diameter, you discontinue the stimulation medication and the Lupron. At this point, you take a human chorionic gonadotrophin (hCG) injection, which matures the eggs and releases them from the walls of the follicles in preparation for the egg retrieval (hCG acts in exactly the same way as luteinizing hormone<\/a> would naturally).<\/p>\n

Progesterone and Estrogen Supplementation<\/strong><\/p>\n

One to two days following the egg retrieval if you are having a fresh embryo transfer, you begin estrogen and progesterone<\/a> supplementation, which are very important for maintaining the lining of the uterus and keeping open a window of receptivity for embryo implantation.<\/p>\n

To summarize, a long Lupron protocol is likely to include the following steps:<\/p>\n