How to decide ovarian stimulation protocol?
Depending on patient age, BMI, Ovarian reserve ( AMH and AFC ), Infertility specialist decide type of stimulation protocol and doses of gonadotrophins. This is called individualised protocol for patient.
Type of Stimulation Protocol ?
- GnRH Antagonist Protocol
- GnRH Agonist Protocol.
sunflower success numbers
1500+
IVF and ICSI procedures a year.
21000+
Live births by IVF and ICSI technology.
Life member
AOGS, AICOG, FOGSI, ISAR, ESHRE, ASRM, IFFS, IMA.
Success rate
70% to 76% in IVF ART.
GnRH Agonist and Antagonist
Multiple follicles in IVF stimulation cycles lead to high estradiol levels, high estradiol levels in turn lead to LH surge which triggers ovulation and rise in serum progesterone levels. Premature ovulation of premature progesterone rise in turn defeats the purpose of ovulation induction. Hence in order to supress this premature LH surge, GnRH agonists and antagonist are administered until the day of trigger.
Advantages of GnRH antagonist protocol
Shorter Treatment Duration:
GnRH antagonists act quickly to suppress LH, allowing for a shorter ovarian stimulation period compared to the longer down-regulation required with GnRH agonists.
Reduced Risk of OHSS:
GnRH antagonists provide more precise control over hormone levels, can use GnRH Agonist as a trigger injection , potentially lowering the risk of OHSS, a serious complication of IVF.
Improved Patient Convenience:
The shorter treatment duration and fewer injections associated with the antagonist protocol can improve patient comfort and convenience.
Flexibility in Timing:
GnRH antagonists can be administered later in the cycle, allowing for more flexibility in the timing of ovarian stimulation.
Gonadotropins
What is gonadotropins?
- Gonadotropins are FSH and LH hormones that are responsible for the events which ultimately result in ovulation.
- FSH and LH when given in pharmacological doses can be used for multifollicular development in a single menstural cycle.
Why are they only available in injectable form?
These hormones are only available in the injectable form, as they are broken down by the gut.
Injectables versus oral medications
They are more expensive than the oral medications.
Their dosing needs to be fine tuned, else will lead to a sub optimal response or hyper response.
Formulations
- They are available in both urinary and recombinant forms.
- Urinary forms are cheaper but have a disadvantage of leading to allergic reactions in few patients and less consistent results.
- Recombinant gonadotropins though more expensive, have an advantage of nearly null allergic reactions and more consistent results across number of cycles and patients.
Protocols for ovulation induction for Timed intercourse or Intra uterine insemination cycles
- Step up
- Step down
- Low chronic step up
