Stimulated In Vitro Fertilization (IVF) with Ovarian Stimulation

Stimulated In Vitro Fertilization (IVF) with ovarian stimulation is when the ovaries are stimulated through medication to produce more than one egg. In a natural cycle, a woman produces one follicle each month. During the ovarian stimulation process, the goal is to produce about 8 to 15 follicles, as this significantly increases the chances of achieving a pregnancy. Three primary protocols are used during ovarian stimulation IVF: the long protocol, the short protocol, and the antagonist protocol.

Long Protocol

In the long protocol of stimulated IVF, drugs similar to GnRH and gonadotropins are administered. This protocol is divided into two stages. The first stage begins:

  • On the 21st day of the cycle (in women with a regular 28-day cycle),
  • On the 2nd day of the cycle, or
  • On the 17th day of taking a contraceptive or three days before the last pill.

This is done with the administration of GnRH agonists (e.g., Arvekap, Daronda) for 14 days. During the second stage of the long protocol, while continuing the GNRH-analog treatment, the administration of gonadotropins and stimulation drugs (such as Puregon, Gonal, Meriofert, and Menopur) begins.

Short Protocol

The short protocol for stimulating the ovaries begins on the 2nd day of the woman’s cycle with the administration of GnRH agonists. On the 3rd day, the ovarian stimulation drugs are administered at the predetermined dose. On the 5th day of stimulation, a transvaginal ultrasound is performed to monitor progress and adjust the dosage. When the follicles reach a diameter of 18-20mm, chorionic gonadotropin (Ovitrelle) is administered, and egg retrieval takes place 34 to 36 hours later. This protocol typically lasts between 12 to 14 days.

Protocol Using Antagonist

The short protocol with GnRH antagonist is an ideal ovarian stimulation IVF treatment for women with polycystic ovary syndrome, egg donors, or women at increased risk of developing ovarian hyperstimulation syndrome. It is also commonly used for women who cryopreserve their eggs. In this protocol, ovarian stimulation starts on the 2nd day of the menstrual cycle at the dose determined by the doctor, continuing for five consecutive days. On the 6th day of stimulation, a vaginal ultrasound is performed to evaluate the ovarian response. If the follicles measure 13-14mm, a GnRH antagonist is administered 2-4 hours before the gonadotropin. The duration of this protocol is approximately 10-12 days. When the follicles reach 18mm, chorionic gonadotropin is administered, and egg collection is scheduled for 36 hours later.

Individualized Treatment Protocols

Stimulated IVF treatment protocols are tailored to each patient’s pathology, age, and medical history. The ideal protocol is the one that yields the largest number of quality eggs from the specific woman, ultimately leading to the creation of good embryos and increasing the chances of a successful pregnancy.