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"Short" and "long" protocol for ovarian stimulation

"Short" protocol: the modern standard

Also called external fertilisation: Treatment with stimulating hormones (FSH, FSH/LH, hMG) takes place after hormone analysis and/or ultrasound from the second or third day of the cycle when bleeding has started. The hormone can be administered by the patient herself or by her partner, under the abdominal skin with easy-to-use injection sets or a pen. A few days later, a second hormone, which suppresses premature ovulation (an antagonist) is administered in the same way as the stimulating hormone. During treatment with these hormones, the growth and ripening of the ovarian follicles is observed using ultrasound and hormone testing.

When a sufficient number of ripe ovarian follicles are available, the stimulation treatment is stopped and the last necessary step, the maturation of the egg cell, is initiated with the injection of another hormone, for example hCG, which then also triggers ovulation. Some 35-36 hours later, we carefully remove the egg cells by means of follicular/ovarian puncture.

Stimulation of the ovaries can cause a higher number of ovarian follicles to ripen. This increases the chance of having several egg cells, and consequently the success of the fertility treatment!

"Long" protocol

The long protocol, also called agonist scheme, is less patient friendly and therefore more rarely applied.

Treatment according to the long protocol is initiated in the preceding cycle. An agonistic hormone is administered to functionally suppress the pituitary during the subsequent follicular stimulation, Thus premature ovulation is prevented.

After this pretreatment the stimulation cycle begins. Following menstrual bleeding the hormonal status is analyzed and/or ultrasound is performed to ensure that the ovaries are free of cysts and in the desired resting state. Now stimulating hormones (FSH, FSH/LH, HMG) can be administered subdermally in the abdominal wall by the patient herself or by her partner, using an injection syringe or a pen. By ultrasound and hormone checks follicular growth and maturation are followed up.

Hormonal treatment is terminated when sufficient mature follicles are availabe. Now HCG is injected which would normally initiate ovulation. About 35-36 hours later, prior to ovulation, the oocytes are retrieved by follicular puncture.