Long IVF protocol by day
Not always a woman can become pregnant after a short scheme of artificial insemination. We talk about another way – a long IVF protocol

Ovulation induction during IVF is usually carried out according to a specific protocol – instructions that determine the drugs, doses and the order in which they are taken (1). There are many protocols, but the most commonly prescribed are long or short. The long protocol is used less frequently. But there are situations in which it is most effective.

When to use long IVF protocol

The name is associated with the duration of taking stimulant drugs. It usually takes about 40-50 days.

A long protocol is needed to achieve the maturation of more eggs. To do this, the natural production of sex hormones by the ovaries is suspended. On an artificially created hormonal background, you can completely control the maturation of follicles.

A long protocol is recommended in the presence of a low ovarian reserve (women with a high reserve have a higher risk of a complication, hyperstimulation syndrome). A long protocol is prescribed for many diseases of the female reproductive system. In particular, with endometriosis and uterine fibroids.

Advantages and disadvantages of a long IVF protocol

The main disadvantages of long IVF include:

  • violation of the menstrual cycle;
  • increased risk of developing ovarian hyperstimulation (2);
  • possible temperature rises;
  • increased psychological stress.

Of course, the method also has advantages:

  • this is often the last chance for women with endometriosis;
  • allows you to give birth to patients with low AMH (anti-Mullerian hormone, a marker of the “reserve” of eggs);
  • minimal risk of adverse reactions and harm to health.

To reduce the risk of adverse reactions, it is necessary to choose a competent specialist and strictly follow his instructions.

Scheme of the long IVF protocol

The traditional scheme of the long protocol consists of 5 stages.

  1. In the luteal phase of the menstrual cycle, i.e. on the 20-22nd day, drugs are prescribed – agonists of gonadotropic hormones. They stop the production of hormones by the ovaries. Dosages of drugs are selected individually for each patient.
  2. Ovarian stimulation begins on day 1-3 of the next cycle. Follicle growth is stimulated by prescribing luteinizing and follicle-stimulating hormones. The follicles begin to grow over the next 13-15 days.
  3. Before the puncture, an injection of human chorionic gonadotoprin (hCG) is prescribed as an ovulation trigger. A puncture to obtain eggs is usually carried out from the 15th to the 22nd day of the cycle.
  4. The most important stage of the protocol is the embryo transfer.
  5. After the transfer, hormonal drugs are prescribed to maintain early pregnancy.

After 2 weeks, an hCG analysis is done and thereby confirms the onset of pregnancy.

Commentary of a fertility specialist

“Currently, there are many different protocols for stimulating superovulation in IVF programs,” notes reproductive specialist Svetlana Murashko, “The long protocol appeared a long time ago, at the dawn of assisted reproductive technologies, but now it is less and less often chosen by fertility doctors for stimulation.

Popular questions and answers

Selection of IVF protocol 一 is a matter of a specialist! But that doesn’t mean patients don’t have questions. We answer the most popular.

What is the difference between a short IVF protocol and a long one?

The difference between long and short protocols lies primarily in the duration. The long protocol covers 2 menstrual cycles and is about 40 days long. This is due to the fact that it has a phase of blockade of ovarian function. After it, ovulation stimulation begins. In the short protocol, blockade of ovarian function is not performed. Stimulation of ovulation is produced here at the first stage. Today, the short protocol is used in 95% of cases. That is what happens on the first try. If the pregnancy did not take place, the second time the doctor may conduct a long protocol.

How do periods come in a long IVF protocol?

Periods in a long protocol usually come on time. In case of a delay or earlier onset of menstrual flow, you should contact your doctor (3).

How is it carried out?

From 19-21 days of the cycle, the introduction of GnRh agonist preparations begins. Injections are administered subcutaneously and daily until the menstruation itself, usually 10-14 days.

From 2-3 days of the cycle, sometimes later, injections of stimulating gonadotropins are prescribed, which cause the growth of follicles. The agonist injections are continued.

When the follicles reach maturity, an ovulation trigger is introduced and a transvaginal puncture of the follicles is performed.

This stimulation option is convenient for the doctor and the patient, since fewer ultrasound examinations and visits are required.

There is evidence that this version of the protocol has advantages for patients with endometriosis, uterine fibroids.

Of pros it is worth noting a more uniform synchronous growth of follicles, and the possibility in some cases to get a slightly larger number of eggs.

The effectiveness of long and other stimulation protocols is approximately comparable.

Cons long protocol – increases the duration of stimulation, and hence its cost.

The risk of developing severe ovarian hyperstimulation syndrome increases, since when using this protocol, it is impossible to replace the final trigger injection intended for egg maturation, therefore, with a high value of anti-Müllerian hormone, this protocol is not used.

Sources of

  1. Kogan I.Yu., Gzgzyan A.M., Lesik E.A. / Protocols of ovarian stimulation in IVF cycles. Management // 2018
  2. Korneeva, I.E. / Ovarian hyperstimulation syndrome // 2007
  3. A.A. Amirova, T.A. Nazarenko, N.G. Mishiev / Problems of reproduction // 2010

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