IVF short protocol by day

IVF protocol is a procedure for administering an individually selected combination of hormonal drugs. Medicines are needed to stimulate the work of the ovaries so that several eggs mature at once.

The protocol clearly states in what doses and for how long these drugs should be taken.

When is short IVF protocol applied?

The short protocol has a number of advantages over the long protocol and is performed much more frequently. (one)

Its differences: a lower risk of developing ovarian hyperstimulation syndrome, which can occur with the use of high doses of hormones. With this syndrome, up to 20 follicles can mature simultaneously. The condition is accompanied by bloating, pain, increased capillary permeability and, as a result, the development of edema.

The short protocol is prescribed for patients with healthy ovaries, unsuccessful attempts at the long protocol, and women over the age of 35 years.

Scheme of a short IVF protocol

The short protocol is adjusted to the woman’s menstrual cycle.

The short protocol scheme includes 4 stages.

• Stimulation of ovulation.
• Ovarian puncture and egg retrieval.
• Embryo incubation.
• Transfer of the embryo into the uterus.

Stimulation begins on the 3rd day of the cycle. The drugs are administered within 2-2,5 weeks. During this period, the patient regularly visits a doctor and takes tests for hormones.

After the follicles have matured, an ovulation trigger is injected – chorionic gonadotropin (hCG) or a gonadotropic releasing hormone (GnRH) agonist. After that, an ovarian puncture is performed and an egg is obtained. The procedure is prescribed on the 15-20th day of the cycle.

The next stage is the selection of the surviving and highest quality eggs. The selected eggs are fertilized with the partner’s sperm.

Cultivation of embryos is carried out in a special nutrient medium. After a few days, the embryologist evaluates their development and quality. The embryos are then transferred to the uterus.

To support pregnancy for the first 14 days after the transfer, the doctor prescribes progesterone preparations. These days you can not go in for sports, ride a mountain bike, go to the sauna. But lying in bed is not recommended. Quiet long walks in the fresh air are best at this time.

The first 14 days after the transfer, tests for hCG are not indicative, they should not be done. Only after two weeks you need to go to the clinic and take an analysis, which is an indicator of pregnancy.

Are the test results positive? Congratulations, you are pregnant.

How long does a short IVF protocol take?

The short protocol usually lasts no more than 28-36 days.

Expert reviews with recommendations

“Short is one of the most commonly used protocols,” notes Reproductologist Tatyana Kobeleva. – The start of stimulation begins on the 2nd-3rd day of the menstrual cycle in which the puncture will take place. It takes a minimum number of days from the start of stimulation to puncture, hence the name.

The main rule of the beginning of this program is the “synchronization” of the follicles. Simply put, at the start of the protocol, all follicles should be the same size.

The short protocol can be used at any age and for any indication, as long as the start conditions are met.

But there is a category of patients for whom this is a “protocol of choice”.

The first group is women with a possible risk of developing ovarian hyperstimulation syndrome (OHSS). One of the main criteria is the visualization of 10-12 or more follicles in each ovary by ultrasound on the 2nd-3rd day of the menstrual cycle.

The indication is based on the ability to replace the trigger and cancel the transfer, since the main measure for the prevention of OHSS is the separation of stimulation, transfer and the abolition of the use of hCG preparations.

The second category is oocyte (egg) donors. The amount of hormones with a short protocol is less, it is safer.

Let’s move on to the diagram.

Most often, under the “short protocol”, a stimulation scheme using GnRH antagonists is used.

Start – 2-3 days from the start of menstruation. An ultrasound is performed and, subject to all the above conditions, the doctor prescribes daily injections of gonadotropins.

Further, under the control of ultrasound, the growth of follicles is assessed. When the dominant follicle reaches size 13-14, daily injections of GnRH antagonists (Cetrorelix or ganirelix) are prescribed to prevent premature luteinization. If in simple words – in order to prevent the early maturation of the follicle and its transition to the corpus luteum (3).

Further, under the control of ultrasound, the growth of follicles is assessed, and when the leading follicles reach 20 mm, a trigger is prescribed.

After, after about 36 hours, a puncture (fence) of the follicles is performed. And that’s where the stimulation ends. Further, it is mandatory to support the second phase during the transfer in this cycle.

This scheme is now widely used. It should be noted that according to ESHRE (European Society of Reproduction), there is no significant difference between the short and long protocols in terms of the frequency of pregnancy and childbirth.

Popular questions and answers

Although a lot has been written about IVF, patients still have questions. We answer the most popular short protocol procedures.

Sources of

1. Kogan I.Yu. Ovarian stimulation protocols in IVF cycles: a guide for physicians / 2017
2. Rudakova E.B. Essays on in vitro fertilization / 2019
3. Kuzmichev L.N. In vitro fertilization / 2001