Understanding Different IVF Protocols

What is IVF?In Vitro Fertilization (IVF) is a fertility treatment where eggs and sperm are combined outside the body to create embryos, which are then transferred to the uterus.

Why Are There Different IVF Protocols?

Every patient is unique. Different protocols are used to optimize your chances of success, minimize risks, and tailor treatment to your specific needs.

Priming Protocols in IVF

What is Priming?Priming refers to medications or hormones given before starting ovarian stimulation to help improve the response of the ovaries.

Common Priming Protocols

• Oral Contraceptive Pill (OCP) Priming:

  Birth control pills may be used for 2–4 weeks before starting stimulation to regulate your cycle and synchronize follicle development.

  
  

• Estrogen Priming:

  Oral or patch estrogen is given in the luteal phase (after ovulation and before your period) to help synchronize follicle development and improve egg yield.

  
  

• Estradiol + Progesterone Priming:

  Both estrogen and progesterone are given in the luteal phase to further suppress natural hormone fluctuations and improve synchronization.

  
  

• Androgen Priming (e.g., DHEA, Testosterone):

  Supplements like DHEA or testosterone gel may be used for several weeks before stimulation to increase response of small follicles to injectable gonadotropins (FSH) during the ovarian stimulation phase.

  
  

Dr. Dason will discuss with you whether a priming protocol is appropriate for your situation.

Common IVF Protocols

1. Antagonist Protocol (Short Protocol)* most commonly used initial protocol

• How it works: Starts with ovarian stimulation medications, then adds a GnRH antagonist to prevent premature ovulation.

• Pros: Shorter duration, fewer side effects, lower risk of OHSS.

  
  

2. Long (Agonist) Protocol

• How it works: Uses medications called GnRH agonists to temporarily turn off your natural hormone cycle in the menstrual cycle before starting stimulation.

• Pros: possible reduction in risk of premature ovulation

• Cons: Longer duration, more injections, possible side effects like hot flashes, higher risk of OHSS for patients with higher AMH

  
  

3. Microdose Flare Protocol

• How it works: Uses low doses of GnRH agonists to “flare” or boost your body’s own hormone production at the start of stimulation.

• Pros: May improve response in women with low ovarian reserve or unexpected prior poor response to ovarian stimulation

• Cons: More complex medication schedule.

  
  

4. Natural or Minimal Stimulation Protocol

• How it works: Uses little or no medication to stimulate the ovaries, relying on your body’s natural cycle.

• Pros: Fewer medications, lower cost, lower risk of side effects.

• Cons: Fewer eggs retrieved

  
  

What to Expect

• Personalization: Your doctor will recommend a protocol based on your age, ovarian reserve, medical history, and previous response to fertility treatments.

• Monitoring: All protocols require close monitoring with transvaginal ultrasounds and blood tests.

• Adjustments: Protocols may be adjusted during your cycle to optimize results.

  
  

Additional Decisions in Your IVF Journey

Dr. Dason will discuss these important options with you and help decide what is best for your situation:

IVF vs. ICSI

• IVF (In Vitro Fertilization): Eggs and sperm are combined in a dish, and fertilization happens naturally.

• ICSI (Intracytoplasmic Sperm Injection): A single sperm is injected directly into each egg.

  • When is ICSI used? Often recommended for male factor infertility, previous failed fertilization, or certain genetic concerns.

    
    

Fresh vs. Frozen Embryo Transfer

• Fresh Transfer: Embryos are transferred a few days after egg retrieval, in the same cycle.

• Frozen Transfer: Embryos are frozen and transferred in a later cycle.

  • Considerations: Frozen transfers may be recommended for certain medical reasons, or to allow your body to recover before transfer.

    
    

PGT-A (Preimplantation Genetic Testing for Aneuploidy)

What is PGT-A?PGT-A is a laboratory test performed on embryos created during IVF to screen for chromosomal abnormalities (aneuploidy) before embryo transfer.

How is PGT-A done?

• After fertilization, embryos are grown in the lab for about 5–6 days (to the blastocyst stage).

• A few cells are gently removed from each embryo.

• These cells are tested to check if the embryo has the correct number of chromosomes.

  
  

Why consider PGT-A?

• May reduce risk of miscarriage: Chromosomal abnormalities are a common cause of miscarriage.

• Embryo selection : Especially helpful if you have several embryos to choose from.

• Reduction in time to pregnancy: By transferring the most viable embryo first.

  
  

Who might benefit from PGT-A?

• Women aged 35 or older

• Couples with a history of recurrent miscarriage

• Couples with repeated unsuccessful IVF cycles

• Couples with known chromosomal rearrangements

  
  

Limitations of PGT-A:

• Cost

• PGT-A does not test for all genetic diseases—only for the number of chromosomes.

• Not all embryos will be suitable for testing or transfer.

• There is a small risk that the biopsy or freezing process could affect the embryo, but this risk is low.

  
  

Dr. Dason will work closely with you to decide which options and protocols are best suited for your individual needs and goals.

*this post does not represent medical advice and is only for general education