Patients with normal ovarian reserve can use either the Lupron protocol or the Antagonist Protocol. These 2 IVF protocols account for about 80% of IVF cycles in the U.S.
The Lupron Protocol
Although it is one of the oldest, the Lupron protocol is still the most popular due to its reliability in producing good quality embryos and high pregnancy rates when used for the correct patient populations.
When Lupron first binds to the pituitary, it causes an initial release of FSH and LH from the gland. With persistent binding, however, Lupron eventually desensitizes the pituitary so that it can no longer respond to brain signal to release its hormones. In other words, after 10 days of Lupron, the pituitary can no longer exert any effect on the ovaries. Ovarian stimulation can then begin safely without further concern about premature ovulation.
The entire IVF process, from the beginning to the day of the pregnancy test, lasts about 6-7 weeks and is consisted of 2 stages- the Pretreatment cycle and the Stimulation cycle.
The Pretreatment Cycle
The main goal of the Pretreatment cycle is to suppress the pituitary to prevent premature ovulation during future ovarian stimulation.
Birth control pill (BCP)
is used to prevent the pituitary from releasing hormones that normally act on the ovaries, thus allowing the ovaries to rest and minimizing formation of ovarian cyst.
is an injectable medication that prevents the pituitary from selecting a single egg and cause premature ovulation. There is a week overlap in which BCP and Lupron are taken together to cause complete suppression of the pituitary. Lupron is continued throughout the stimulation of the ovaries.
The Stimulation Cycle
While the pituitary is under Lupron suppression, the ovaries are stimulated by injectable medications that contain FSH and LH. The response of the ovaries are closely monitored by frequent sonograms and blood test.
HCG (Human Chorionic Gonadotropin) is a hormone that acts similarly to LH to cause final maturation of the eggs. HCG is given once several leading follicles reach mature size.
Is performed about 36 hours after the HCG injection, the procedure takes 20 minutes and is conducted under IV sedation. Under ultrasound guidance, a thin needle is introduced into the pelvic space through the vagina and is used to aspirate eggs from the follicles within the ovaries.
Fertilization and Culture
After their aspiration, the eggs are isolated under the microscope and are fertilized with the sperm the same day. Fertilized eggs are cultured for 5 days.
On the fifth day of culture, one or two embryos are transferred into the uterus using a soft catheter. The procedure is similar to an IUI, does not hurt and does not require sedation. Any remaining embryos can be frozen for future use if it meets criteria.
Progesterone is important for the maturation of the endometrium and maintenance of pregnancy.