The micro-Lupron protocol was one of the first aggressive protocols introduced for patients with low ovarian reserve.
Lupron binds to the pituitary to cause the release of FSH and LH to eventually exhaust the pituitary of these hormones so that the brain and pituitary can no longer regulate the function of the ovaries. Once the natural selection mechanism is removed, ovarian stimulation can begin to recruit multiple follicles .
In the classic protocol, Lupron and BCP are used for at least 10 days before stimulation. In some patients, this combination can be a potent suppressor of ovarian response. In contrast, the micro-Lupron regimen uses a very small amount of Lupron (1/20 the usual dose) just 3 days before ovarian stimulation in order to release LH and FSH from the pituitary. Thus during the first 2-3 days of micro-Lupron, the ovaries are stimulated by pituitary FSH and LH (the flare effect). On the third day of micro-Lupron, medications containing FSH and LH are added to further augment the stimulation. After a week, the pituitary finally is exhausted of its LH and FSH and can no longer interfere with the stimulation process by either selecting the dominant follicle or causing ovulation.
The micro-Lupron protocol was one of the first aggressive protocols introduced and over the years has helped many patients with low ovarian reserve to conceive their own children without resorting to donor eggs. Its main disadvantage is that LH is also released along with FSH, which theoretically can negatively impact egg development. However, several studies have demonstrated that some early LH is necessary for optimal development of follicles. The other disadvantages are the increased risk of premature ovulation near the end of the stimulation process due to minimal pituitary suppression, and the potential inhibition of BCP on ovarian response in patients with very low egg reserve (AMH < 0.5 ng/ml).
At IVFMD, we found that the microdose Lupron protocol works best in patients with ‘borderline’ ovarian reserve, ie those with AMH level of 0.8-1.2 ng/ml and/or antral follicle count of 5-10.