Discover the 3 most common IVF protocols—long, short, and Duostim—and their roles in your fertility treatments.

Introduction

Embarking on an IVF journey can feel overwhelming, especially when it comes to understanding the various protocols involved. Each protocol is designed to fit the unique needs of different individuals, ensuring that treatments are as personalized and effective as possible. In this article, we’ll walk you through the three most common IVF protocols: the long protocol, the short protocol, and the antagonist protocol. We understand that this process can be emotionally taxing, and we’re here to help you navigate the details with sensitivity and transparency.

1. The Long Protocol or the Agonist protocol

The long protocol is the most traditional form of IVF treatment and has been widely used for many years. This protocol spans over three to four weeks and begins with down-regulation from day 21 of the previous cycle, where medication is used to suppress the ovaries. The goal is to prevent natural ovulation, giving your fertility specialist full control over the cycle. Once you get your periods, ovarian stimulation begins with the use of hormonal injections to encourage the production of multiple eggs. Once the eggs have matured, they are retrieved and fertilized in the lab or retrieved and frozen in cases of only egg freezing.

 Pros:

•  Control over the cycle: The long protocol offers more control over timing, which can optimize egg quality.
• Established success rates: This protocol has been used for decades and boasts a solid track record of success.

 Cons:

• Time-consuming: The treatment can take longer, requiring more patience and commitment.
• Side effects: Because it involves hormonal suppression, some women may experience side effects like mood swings, hot flashes, and fatigue.
• Nowadays, it is often used as a second-line protocol, in case the short protocol doesn’t work as expected.

 2. The Short Protocol or the Antagonist protocol

The short protocol, as the name suggests, is a quicker approach to IVF. It skips the down-regulation phase and begins with ovarian stimulation right at the start of the cycle. By shortening the overall treatment time, this protocol can be less demanding both physically and emotionally. The short protocol is often recommended for most women.

 Pros:

• Faster process: The short protocol reduces the overall treatment time, which can make the experience less stressful.
• Lower risk of OHSS or ovarian hyperstimulation syndrome: This protocol is often recommended for women who are more prone to ovarian hyperstimulation, especially women with PCOS.
• Lower medication use: Since it skips the down-regulation phase, there may be fewer medications involved.

 Cons:

• Less control over timing: Without the down-regulation phase, there may be slightly less control over egg maturation.
• Lower success rates for some: It may not be as effective for women with certain fertility challenges, such as those with low ovarian reserve.

3. Duosim Protocol 

Also called Dual stimulation, it is a newer protocol designed to maximize the number of oocytes retrieved in one cycle. In this protocol, a second round of stimulation with fertility medications can be started during the luteal phase (the period after the first egg collection is done) allowing a second egg collection in the same menstrual cycle.

Pros:

• Tested in women with fewer eggs: Women with a low ovarian reserve who produce relatively few eggs in a given cycle undergo 2 retrievals in the same cycle
• Cancer therapy: Women undergoing chemotherapy for cancer and have limited time to freeze their fertility 

Cons:

• Cancellation risks: There is an increased cancellation risk during the second (luteal phase) stimulation. 
• Cost: The cost-effectiveness of these protocols has yet to be established.

Priming:  Priming involves taking a birth control pill or estrogen pills for few days before starting the IVF cycle. This is known as priming, which is used to schedule the timing of your IVF cycle. 

Priming also helps women with Diminished Ovarian Reserve or those with an asynchronous follicular growth on ovarian stimulation.

Conclusion

Choosing the right IVF protocol depends on several factors, including your medical history, age, ovarian reserve, and how your body responds to stimulation. It’s important to have an open discussion with your fertility specialist about your options. Each protocol has its strengths, and the goal is to tailor the treatment to your unique circumstances, offering you the best possible chance for success.

FAQs:

1. How do I know which IVF protocol is best for me? 

Your fertility specialist will assess your medical history, age, and ovarian reserve to recommend the best protocol for you. It’s important to have a thorough conversation about your options and what you feel most comfortable with.

2. Are success rates higher with the long protocol?  

No protocol has been established as superior. However, your fertility specialist will consider your unique circumstances when determining the most effective protocol.

3. Can the short protocol work for women with low ovarian reserve? 

The short protocol is generally more effective for women with a good ovarian reserve. For women with a lower reserve, the antagonist or long protocol may be more beneficial. But again, the data from these studies does not uphold one protocol over another. Always consult with your doctor to discuss what’s right for you.

4. How does the antagonist protocol reduce the risk of OHSS?

The antagonist protocol uses medications to block natural ovulation during stimulation, which helps control the ovarian response and reduces the risk of ovarian hyperstimulation syndrome (OHSS), a potential complication in IVF treatments.