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StimulationProtocol

Stimulation Protocols :

There are 3 different protocols for administering the drugs; each has its pros and cons. Each patient has her own unique response to the medications she receives and each ART cycle is different The ovarian response varies between patients and in different cycles in the same patient, both in the number of follicles produced and the speed at which they mature. The number of follicles is no guarantee of the number of eggs that will be collected.

 

IVF Cycle with the Long Protocol

Currently, the long protocol is preferred because it is more convenient and has shown superior efficacy.

Below is a standard IVF cycle outline that summarizes the important steps involved in the long protocol

Agonist inj. from day 21 of previous cycle

for approx 15 days - Menstruation will start within a week .


Baseline Ultrasound / Serum E2 levels

Pituitary is turned off, ovaries are inactive, the lining of the womb is thin




Agonist inj. + Stimulation with FSH/HMG

Pituitary turn off maintained on a lower dose of agonist inj.
Stimulation of the ovaries started with HMG/FSH - Day 1 
USG & Hormone assays on day 6, day 8, day 10, day 12
Approx. 10-12 days



Agonist inj. +Trigger Shot of HCG
Induces ovulation and final maturation of the eggs
carefully timed (usually given at night)



EGG RETRIEVAL
(34-36 hours after trigger shot)



EMBRYO TRANSFER
(3 or 5 days after retrieval)



Pregnancy Test
(14 days after Embryo Transfer)



Ultrasound
1st -10 days after +ve pregnancy test
2nd -18 days after +ve pregnancy test

 

IVF Cycle with the Short Protocol

The short protocol is used in patients who have responded poorly to the long protocol and in those who are likely to be more resistant to ovarian stimulation - usually patients over the age of 35years. The total duration of treatment is much shorter than the long protocol.

Baseline Ultrasound
High dose of Agonist inj. from day 1-3 of period
for initial stimulation of the pituitary to recruit more eggs

 
High dose of Agonist inj. + Inj HMG on day 3 of cycle
Low dose of Agonist inj. + Inj HMG from day 4 of cycle onwards
for approx. 10 days
 Pituitary is turned off by agonist and
ovaries stimulated by HMG 
USG & Hormone assays on day 7,day 9,day 11



Agonist inj.  + Trigger Shot of HCG
to induce ovulation and final maturation of the eggs



Egg Retrieval
(34-36 hours after trigger shot)



Embryo Transfer
(3 or 5 days after retrieval)



Pregnancy Test
(14 days after Embryo Transfer)



Ultrasound
1st -10 days after +ve pregnancy test
2nd -18 days after +ve pregnancy test

 

IVF Cycle with the ANTAGONIST

The advantage of this protocol is the shorter duration of the stimulation and lower dose of FSH/HMG required as compared to the long protocol. Also, in patients with PCOS, mildly hyperstimulated cycles need not be cancelled as ovulation can be triggered with the Agonist inj. This reduces the chances of complications of OHSS. 

Baseline Ultrasound
FSH/HMG from 1st day of period



Antagonist + HMG/FSH from day 6
Pituitary turned off by Antagonist
HMG/FSH stimulates ovaries
USG & Hormone assays on day 6, day 8, day 10



Antagonist +Trigger Shot of HCG
to induce ovulation and final maturation of the eggs



Egg Retrieval
(34-36 hours after trigger shot)



Embryo Transfer
(3 or 5 days after retrieval)



Pregnancy Test
(14 days after Embryo transfer)



Ultrasound
1st -10 days after +ve pregnancy test
2nd -18 days after +ve pregnancy test.

About 5-10% of the treatment cycles are cancelled as a result of poor or excessive response to the ovulation drugs. If fewer than three mature follicles develop, the outcome of the treatment is likely to be unsuccessful and we may advise cancelling the treatment cycle. In these cases, if the Fallopian tubes are normal and there is no severe male factor infertility problem, the cycle may be converted to an intrauterine insemination cycle.

Once the eggs are picked up any of the following procedures may be carried out

  • In Vitro Fertilisation - IVF
  • Intra Cytoplasmic Sperm Injection - ICSI
  • Zygote Intra Fallopian Transfer - ZIFT
  • Gamete Intra Fallopian Transfer - GIFT
 

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