Navigating IVF treatment

A course of IVF is referred to as a “cycle” rather than simply a procedure. That’s because this carefully timed process follows the steps of your menstrual cycle.

When you’re starting an IVF cycle, you may be prescribed several fertility medications to stimulate follicle development in your ovaries. This is what is called an IVF protocol. IVF protocols are composed of several fertility drugs, some of which are injected or administered vaginally.

There is no standard protocol. Each woman’s IVF protocol should be designed based on clinical parameters and individual needs.

The following are examples of common IVF protocols:

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Long agonist protocol (downregulation protocol)

What may happen

A long agonist protocol is started in the second half of the cycle before your planned treatment cycle. A gonadotropin-releasing hormone (GnRH) agonist is taken daily to prevent the release of the body’s natural follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is done to prevent the natural ovulation event. An injectable gonadotropin is added to the protocol to make multiple follicles grow. When the follicles reach a certain size and number, human chorionic gonadotropin (hCG) is administered to trigger final maturation of the eggs so they are ready for retrieval.

Antagonist protocol

What may happen

FSH is started on cycle day 2 or 3. Once follicles reach a certain size, or gonadotropins are given for a certain number of days, a GnRH antagonist is given to prevent ovulation. After reaching center-specific criteria (possibly based on follicle size), hCG or a GnRH agonist is administered to trigger maturation of the eggs so they are ready for retrieval.

Flare protocol

What may happen

A GnRH agonist is given in the cycle when stimulation will occur, which causes a flare or release of FSH and LH from the pituitary. Flare protocols take advantage of the temporary increase in FSH and LH to drive the development of follicles. Injectable gonadotropin is given to keep the follicles growing. When the follicles reach a certain size and number, hCG is administered to trigger final maturation of the eggs so they are ready for retrieval.

Whatever protocol or combination of fertility medications you are given for ovarian stimulation, it’s important to take them at the dose and time your doctor prescribes. Timing is key in all IVF protocols.

Fertility drugs used during an IVF cycle

IVF cycles may involve a number of different fertility medications, all of which may affect you in some way. Commonly prescribed drugs for ovarian stimulation are:

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Clomiphene citrate

What it’s for

  • To stimulate ovulation in women who have infrequent or absent ovulation
  • To use with IUI as an empiric treatment for unexplained fertility issues
  • ASRM recommends no more than 3 to 4 cycles before further fertility evaluation is necessary

Follicle-stimulating hormone (FSH)

What it’s for

  • To stimulate the ovaries to produce multiple follicles in an IVF cycle
  • To cause ovulation in a patient who does not ovulate regularly

Gonadotropin-releasing hormone (GnRH) agonist

What it’s for

  • To block the LH surge during stimulation phase of the IVF cycle, preventing premature ovulation.
  • To downregulate the natural hormones for a more controlled treatment cycle

Human chorionic gonadotropin (hCG)

What it’s for

  • To trigger final follicle maturation and ovulation

Human menopausal gonadotropin (hMG)

What it’s for

  • To stimulate the development of multiple follicles in an IVF cycle

There are many other fertility medications that are used during an IVF cycle, so be sure to ask members of your healthcare team about these medications and how they may affect you.