The E2-primed Low Lupron protocol was introduced to address the problem of early LH release seen in the micro-Lupron flare protocol.
Unlike the classic Lupron protocol, no BCP is used in the pre-stimulation cycle. Lupron is started about a week after ovulation, its dose is halved at menses, and further halved when stimulation begins. Estrogen is added on day 3 of menses and is continued throughout the stimulation phase.
As in the regular Lupron protocol, this regimen uses extended Lupron pretreatment to eliminate any potential negative effect of LH during the initial phase of stimulation. The sequential decrease of Lupron dose aims to offset the suppression side effect of the medication. Estrogen also provides a beneficial hormonal milieu for follicular development.
The main disadvantage of the E2-Lupron protocol is that the prolonged pituitary inhibition with Lupron, albeit a reduced doses, can lead to pronounced suppression of ovarian response in patients with AMH <0.5 ng/ml. In addition, ovarian cyst can form from Lupron-induced release of FSH, which may necessitate longer use of Lupron and can further delay stimulation. In our experience, the stimulation duration for this protocol tends to be protracted and the medication requirement can be very high.