So you’re doing IVF? Congrats! Your doctor will recommend the best IVF protocol (course of treatment) based on your diagnosis. The 5 types of IVF protocols below are the most common, but may not look exactly like your peers. The choice of medication and dosages will vary from woman to woman.

The sobering truth is that while IVF has been around for over 40 years, protocols are still administered on a trial and error basis. While most women will respond well to the Antagonist/Short protocol, others may require multiple IVF rounds to find the right protocol and medication cocktail for them.

This is where Embie’s mission becomes so important. By collecting diagnosis and IVF protocol information from thousands of women around the world, we hope to find markers for treatment best practices moving forward. This will mean more precise protocols for your specific diagnosis, higher success rates and lower costs for future infertility patients. 

As medicine advances, the 5 below stimulation protocols can be combined with autoimmune protocols, priming protocols (estrogen or testosterone), the addition of HGH (Human Growth Hormone), steroids, and other treatment options subscribed by your RE based on your diagnosis. 

Antagonist IVF Protocol:

The most standard and used protocol in IVF is the Antagonist a.k.a. Short protocol. It has a high success rate amongst younger patients, those with higher ovarian reserve (AMH/AFC), PCOS diagnosed patients, and those of African American and Asian ethnical backgrounds.

Antagonist Protocol Treatment usually follows the below protocol:

  1. Begin with two weeks of Birth Control Pills to suppress the ovaries.
  2. Stop BCP, wait for Menstrual cycle and begin Stimulation drugs such as Follicle-stimulating hormone (FSH) and/or Human menopausal gonadotropin (hMG, combines LH and FSH) on CD2 or CD3. 
  3. Starting around the fifth day of stimulation, the Gonadotropin-Releasing Hormone (GnRH) antagonist is added to prevent premature ovulation.
  4. Once your follicles have been determined to be ready, Your doctor may use a “Lupron trigger” or “dual trigger” with HCG to promote the final maturation and release of the oocytes 34-38 hours prior to egg retrieval.

Long Agonist IVF Protocol:

The Long Agonist a.k.a. Lupron Protocol may be used in older patients or in patients who have poor egg and embryo quality from other protocols. It has also been found to improve the clinical pregnancy rate of patients with stages III–IV endometriosis and those with lower ovarian reserve (Low AMH/AFC).

Long Agonist Treatment usually follows the below protocol:

  1. Begin with two weeks of Lupron/Decapeptyl, a.k.a Gonadotropin-releasing hormone agonist (GnRH agonist), to suppress the ovaries. Some patients may be given BCP prior to the administration of the GnRH agonist medications. 
  2. Once the ovaries have been determined to be sufficiently suppressed via ultrasound and lab results (Low Estrogen, LH and FSH levels), stimulation drugs will be administered. Follicle-stimulating hormone (FSH) and/or Human menopausal gonadotropin (hMG, combines LH and FSH) will be taken for 10 to 20 days depending on the patient’s response. 
  3. GnRH Agonist (Lupron/Decapeptyl) will continue to be taken at a lower dose throughout the stimulation portion of the protocol to prevent premature ovulation. 
  4. Once your follicles have been determined to be ready, Your doctor will instruct you to administer a HCG trigger to promote the final maturation and release of the oocytes 34-38 hours prior to egg retrieval.

Flare IVF Protocol:

Called the Flare, the Microdose Flare, or the Low dose Lupron protocol, this regimen uses the same medications as the Long Agnois protocol. The major difference is that, by cutting the dose of Lupron down to one sixth of the routine dose, and by giving it twice daily, the Lupron actually turns the pituitary gland “on” rather than “off”, producing a major release of FSH.  

Much like the Long Protocol, it is subscribed to poor responders and women of older maternal age or low ovarian reserve (AMH/AFC).

Flare Protocol Treatment usually follows the below protocol:

  1. You’ll begin down regulation using a microdose of Lupron/Decapeptyl, a.k.a Gonadotropin-releasing hormone agonist (GnRH agonist), twice a day for a very short period of 3 to 5 days starting on CD1-CD3.
  2. Once instructed by your Clinic, begin stimulation drugs such as Follicle-stimulating hormone (FSH) and/or Human menopausal gonadotropin (hMG, combines LH and FSH) for approximately 10 days, while continuing to take the GnRH agonist. 
  3. Once your follicles have been determined to be ready, Your doctor will instruct you to administer a HCG trigger to promote the final maturation and release of the oocytes 34-38 hours prior to egg retrieval.

Mini IVF Protocol: 

In some rare cases, there are clinics that believe that “minimal” stimulation may provide advantages and improve egg quality in low responders and those with diminished ovarian function. A mini or natural IVF cycle will yield only one or two eggs at a time in hopes of getting quality over quantity.

Mini IVF Protocol Treatment usually follows the below protocol:

  1. Your doctor may advise using fertility pills, such as Clomid and Femara/Letrozole, or very low dosage FSH and hMG medications for a shorter period of time, later in your cycle. This will be determined by monitoring your cycle via ultrasound and lab tests. 
  2. Gonadotropin-Releasing Hormone (GnRH) antagonists may be added to prevent premature ovulation.
  3. Once your follicles have been determined to be ready, Your doctor may use a “Lupron trigger” or “dual trigger” with HCG to promote the final maturation and release of the oocytes 34-38 hours prior to egg retrieval.

Ultimately, ovarian stimulation is a very complex process. With so many different stimulation regimens developed and studied, it’s important for you to discuss your options in detail with your physician and choose the absolute best protocol for your individual circumstances.