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IVF Stimulation Protocols

In vitro fertilization (IVF) is the process of incubating eggs and sperm in a Petri dish and then inserting the eggs back into the patient. IVF is commonly used when a couple is having difficulty getting pregnant on their own. Women choosing a sperm donor to get pregnant will also use IVF. The first step in IVF is retrieving eggs from the female donor. Various stimulation protocols are used to increase the number of eggs that a women drops from one to the eight to 10 that are needed for the best IVF results.

  1. Lupron Stimulation Protocol

    • Lupron ovarian stimulation is most commonly used within the United States to aid in egg retrieval. The process combines a GnRH-agonist drug called Lupron with a follicle stimulation hormone (FSH) to increase the number of eggs released during ovulation. Lupron is started by the patient seven days prior to the start of her menstrual cycle. The ovaries are monitored by an ultrasound to see the eggs mature. When ready, the FSH is taken to stimulate the release of the eggs. This happens between two and seven days after a woman's menstrual cycle begins. For best results, doctors aim to retrieve a minimum of three to four eggs that are 14 to 20 millimeters in diameter. The stimulation process takes between eight and 10 days. Human chorionic gonadotopin (HCG) is the final drug used in the Lupron stimulation protocol. This shot will induce the eggs to fully mature and increase estrogen levels so the follicles release the eggs. Eggs are retrieved between 24 and 36 hours after the HCG is injected.

    Antagonist IVF Protocol

    • If a woman is unable to produce enough eggs for IVF using the Lupron ovarian stimulation, a doctor will next try the Antagonist IVF protocol. A GnRH-antagonist is used to suppress the LH levels in the body that cause ovulation. These shots may be given every four days so that eggs are given the chance to mature before being released by the follicles. FSH is injected daily for seven to 12 days in order to increase egg production. Due to the fact that this procedure is less effective than the Lupron ovarian stimulation at generating mature eggs, doctors aim to retrieve between eight and 15 eggs. HCG is then injected to increase maturation and stimulate the follicles to release the eggs for retrieval.

    Flare and Microflare Stimulation

    • The final option for IVF stimulation is flare or microflare. Women who have been unable to successfully produce the necessary mature eggs using other IVF protocols use this option as the final resort in their attempts to get pregnant. Women who are unsuccessful using other stimulation techniques are typically older or for some reason have a low number of available eggs. First, birth control pills will be prescribed for one month before starting stimulation. Birth control pills supply necessary hormones to increase ovulation and a specific start date for ovulation. On the second day of a woman's menstrual cycle Lupron is injected. On day three, FSH injections start at a rate of one to two doses per day. The ultimate goal is to take advantage of the natural flare in the pituitary gland that occurs during menses in order to stimulate the follicles. Once the eggs reach full maturity, which is monitored by an ultrasound, they are retrieved in hopes of being fertilized with sperm.

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