Control Ovarian Stimulation Protocol

IVF patients will undergo controlled ovarian hyperstimulation with gonadotropin (ovarian stimulatory drugs). These products are administered according to treatment protocols. There are different ovarian stimulation protocols used in IVF programs, our fertility specialist will chose a protocol peculiar to your treatment in order to individualize your treatment.
There two main ovarian stimulation protocols; the agonist and the antagonist protocols.

  1. The Agonist Protocol

The Agonist Protocol entails the following;

  1. Down regulation using the long, short or ultra short protocols. The reason for this down regulation is to prevent premature LH surge
  2. The long protocol means giving the injection on day 21 of cycle preceding the start of stimulation.
  3. The short protocol mean starting down regulation injection on day 1 of the treatment cycle till HCG is given.
  4. For the ultra short protocol for down regulation, the injection is given for 3 days starting from day 1 of cycle.
  1. Antagonist Protocol

The antagonist Protocol entails the following;

  1. The patient sees her period and then controlled ovarian stimulation starts on day 2 or 3 of the menstrual cycle with gonadotropin injection till the day of ovulation induction with HCG.
  2. On day 7 of the menstrual cycle, the antagonist injection is started till the date of HCG administration (fixed antagonist protocol) or the antagonist injection is stated when the leading follicle measures at least 14mm (flexible antagonist protocol) till the day of ovulation induction with HCG.

The decision to use either the agonist or antagonist protocol is determined by certain factors such as;

  • Patient’s age
  • Follicle stimulating hormone (FSH) or anti-mullerian hormone (AMH) level
  • Ovarian morphology
  • Response from previous ovarian stimulation

At JAFC, once the patient protocol is decided and ovarian down regulation is carried out, a baseline ultra sound scan to confirm that the ovaries are properly down regulated and to exclude presence of cysts. Once this is achieved ovarian stimulation using gonadotropin begins.
Controlled ovarian stimulation using gonadotropin begins from day 2 or 3 of the menstrual cycle and last for about 10 to 14 days.
The initial dose of medication used at the start of stimulation may be changed depending on number and size of the follicles, estrogen level or the patient’s protocol.

  1. Patients on controlled ovarian stimulation are subjected to routine ultra sound scans to monitor follicular growth and development.
  1. Ovarian stimulations continue until at least 3 follicles measuring at least 17mm are seen, usually on 10 – 11 days of gonadotropin stimulation, the HCG injection is then given for the final maturation of the follicles.

The gonadotropin dosage is individualized for each patient based on;

  • Age
  • Weight
  • The number of visible follicles
  • Cycle Day 3 FSH levels or AMH level and the response to previous stimulation cycles.
  • Response from previous ovarian stimulation