Protocol refers to the order in which medications are administered. Lupron, a gonadotrophin releasing hormone (GnRH) or a GnRH antagonist hormone (Antagon or Cetritide) are medications used to suppress spontaneous ovulation while gonadotrophin medications stimulate maturation of multiple eggs. The use either the Lupron protocol or the Antagonist protocol. These two IVF protocols account for about 80% of IVF cycles in the U.S.
The stimulation process is monitored using transvaginal ultrasound (TVUS) and hormonal levels through blood tests. Once three or more follicles reach a diameter of 18mm or greater, human chorionic gonadotrophin (HCG) or luteinizing hormone (LH) are used to trigger initial start of egg release. At about 36 hours from HCG or LH surge, oocyte retrieval is scheduled. 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 six to seven weeks and is consisted of the pretreatment cycle and the stimulation cycle.