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IVF Guide
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What In An IVF Protocol?
An IVF protocol is just a fancy title for an IVF treatment plan. It is your personal schedule for how your IVF cycle will be done. It includes details of which fertility drugs will be used, in what dosage and what procedures will be performed at different times of your cycle. Your doctor will decide a protocol for you based on your age, cause of infertility and response to previous fertility treatments or IVF attempts. There are two main types of protocols (but fertility clinics may have sub-categories of protocols within these two groups). The first main type is called a long protocol and it is for women whose hormones are functioning normally and who have regular menstrual cycles. The second type is called a short protocol (also called boost or flare regimes) and it is for women who have high follicle stimulating hormone (FSH) levels or who have responded poorly to ovarian stimulation in the past (so-called 'poor responders'). The medications used in both protocols are the same; however the dosage and timeframe's are different. The long protocol generally takes 6 weeks and the short protocol takes 4 weeks.
Example Of A Typical Long Protocol Plan
| Stage of Menstrual Cycle |
Treatment |
Scans and Tests |
| First Menstrual Cycle |
| Day 2 to 3 |
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Blood test to check hormone levels (FHS, LH and estradiol). |
| Days 21 to 31/33 |
Down Regulation
Suppression drugs (Suprefact, Daronda, Avercap, Cetrotide or Orgalutran) to clear the pituitary gland so that it releases all its stores of FSH and LH hormones. This clears the deck so that it can begin to be manipulated. You continue to take suppression drugs to maintain a balance until egg retrieval. |
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| Second Menstrual Cycle |
| Days 3 to 5 |
Ovarian Stimulation
FSH or FSH/LH combined injections (Menogon, Puregon, Menopur, Gonal-F or Metrodin High Purity) start between day 3 and 5 to stimulate ovulation. These will continue to be taken until the eggs are ready to be retrieved. Suppression drugs continue to be taken. |
Suppression Check on day 3: Ultrasound scan to check for signs of ovarian cysts and/or blood test to check estradiol levels. Birth control pills may be prescribed to suppress cysts if found. |
| Days 6 to10 |
Possible alterations to FSH/LF injections and suppression drugs based on the results of your scan. |
Ultrasound scan/blood tests to measure hormone levels and thickness of womb. |
| Day 11 |
HCG injection, depending on results of scan. Injection is timed 32 to 36 hours before egg retrieval surgery. |
Final Ultrasound scan. |
| Day 12 |
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| Day 13 |
Egg retrieval (follicular aspiration) and sperm collection from man. |
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| Day 14 |
Eggs are fertilized in the lab with sperm. Embryos are graded and incubated. |
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| Days 15 to 18 |
Embryo transfer. |
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Example Of A Typical Short Protocol (Flare or Boost Regime)
The short protocol closely matches the long protocol but starts two weeks later.
| Stage of Menstrual Cycle |
Treatment |
Scans and Tests |
| First Menstrual Cycle |
| Days 2 to 5 |
Ovarian Stimulation
Suppression drugs start on day 2. On day 3 FSH injections start to stimulate ovulation. These will continue to be taken until the eggs are ready to be retrieved. |
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| Days 6 to10 |
Possible alterations to FSH injections and suppression drugs based on the results of your scan. |
Ultrasound scan/blood tests to measure hormone levels and thickness of womb. |
| Day 11 |
HCG injection, depending on results of scan. Injection is timed 34 to 36 hours before egg retrieval surgery. |
Another ultrasound scan. |
| Day 12 |
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| Day 13 |
Egg retrieval (follicular aspiration) and sperm collection from man. |
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| Day 14 |
Eggs are fertilized in the lab with sperm. Embryos are graded and incubated. |
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| Days 15 to 18 |
Embryos implanted into the womb. |
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Names Of Protocols At A Glance
Your fertility clinic may not refer to your protocol as long or short, but may use other names such as Long Lupron, Short Flare or Microdose Flare. Here are some of the most common IVF protocol names:
| Protocol Name |
Patient Profile |
Average Days of Drugs |
Dosage |
| Microdose Flare |
Women over 35 and/or poor responders |
10 to 12 days of Lupron and start stimulating meds on day 5 for 5 to 7 days. |
60 vials of stimulating meds and 1 bottle of diluted microdose Lupron. |
| Short Flare |
Women who became oversuppressed on the Long Lupron protocol |
10 days on Lupron and start stimulating meds on day 5 for 5 to 7 days. |
One 14 day Lupron kit and 24 to 30 vials of stimulating meds. |
| Long Lupron |
Women under 35 and/or good responders |
21 days plus, including at least 10 days of Lupron only |
About 38-40 dosages, plus one 14 day Lupron kit. |
| Cetrotide or Antagon |
Women of any age, and/or those who become oversuppressed on Lupron |
10 days of stimulating meds. Start ganirelix injections on day 6. |
Up to 40 vials of stimulating meds and 5 or 6 prefilled syringes of Cetrotide or Antagon. |
Additional Treatments You Can Add To Your Protocols
The following treatments can be added to a protocol to improve the chance of pregnancy:
Egg donation: If your eggs aren't of great quality.
ICSI procedure: Don't leave it to chance, have the sperm injected in!
Extracting sperm for IVF: Sperm aspiration, if your partner has a low sperm count.
Donor cytoplasm: Improving the quality of your eggs without resorting to egg donation.
Embryo donation: Receiving donor embryos from another couple.
Pre-implantation genetic diagnosis: Embryo testing.
Day 5 embryo transfer: Allowing the embryos to grow longer.
For more, read about assisted reproductive technology.
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