The cycle of in vitro fertilisation (IVF) may start with suppression of the pituitary in order to build egg follicles. Next, stimulation of the ovaries occurs to produce eggs. After ovulation is triggered, eggs are retrieved and fertilised with sperm in a laboratory and fertilised embryos are placed back into the womb. The process of pituitary suppression and stimulating the ovaries to produce eggs is typically completed by one of three different drug or “IVF protocols.” Daily hormone injections are taken to stimulate multiple egg production to further increase the number of eggs given a chance to fertilise, as opposed to a single egg released by the body each month.
Also known as the Lupron protocol or “long Lupron,” the agonist protocol is the standard of IVF stimulation treatments. Lupron is a hormone that is injected daily to suppress pituitary stimulation. This process takes about 10 days. Patients are monitored by ultrasound, and once several follicles have developed, another drug is taken to stimulate the ovaries to produce eggs. The brand names of drugs in this family include Follistim, Bravelle, Gonal-f and Repronex. The last step in this protocol is to take a HCG (human chorionic gonadotrophin) shot which causes final maturation of the eggs.
The antagonist protocol is similar to the agonist, but instead of using Lupron for pituitary stimulation, other drugs are used, which only take one day instead of 10 for treatment. This may be advantageous as less injections are given, and some doctors believe the lack of pituitary suppression may increase the ovarian response in women with fewer eggs. The brand names of the drugs used in this protocol are Cetrotide and Ganirelix. As with the agonist protocol, the last step before egg retrieval is the HCG shot.
The flare protocol may be used when other IVF protocols have failed. Also called the “microflare” or “short Lupron,” Lupron is used in much smaller amounts to release a hormone called FSH from the pituitary to stimulate a natural ovarian response. The day after Lupron is taken, high doses of hormone injections are started to stimulate the ovaries further. Lupron is continued until the HCG shot is administered. The intent of this protocol is utilise natural production, in addition to the injections, to produce a few high-quality follicles rather than a larger quantity. The disadvantage to this protocol is not developing many follicles reduces the chances of multiple egg production.
Another option, the "natural IVF," does not use a drug protocol for pituitary suppression or egg stimulation. No hormones are given to produce multiple eggs and the single egg produced monthly is retrieved, lab-fertilised and transferred back to the uterus. The advantages include lower treatment costs and no side effects from medications; however, the chance of fertilisation is much lower with only one egg.