Programmed superovulation protocols

Programmed superovulation protocols now provide a convenient and effective means of scheduling and organizing a clinical IVF programme, allowing oocyte retrievals to be performed on specific days of the week, or in ‘batches’. A standard protocol that can be used to maximize the number of oocytes recovered uses downregulation with gonadotrophin releasing hormone (GnRH) agonist, commencing in the luteal phase of the previous cycle, and ovarian stimulation with purified follicular stimulating hormone (FSH) by subcutaneous injection.

There are many variations of this standard protocol, and individual ART programmes apply the same strategy with a variety of different drugs and schedules. Downregulation with a GnRH agonist may begin either in the luteal or the follicular phase (‘long protocol’) of the previous menstrual cycle, and can be administered with a depot preparation such as decapeptyl, goserelin or leuprolide, by daily subcutaneous injections, or daily intranasal sniffs. It may also be administered from Day 1 of the treatment cycle and continued until ovulation induction with hCG (‘short protocol’, sometimes also known as ‘flare protocol’). The ‘Ultrashort protocol’ uses only three doses of the agonist, on days 2, 3 and 4 of the treatment cycle. Treatment cycles may also be scheduled by programming menstruation using an oral contraceptive preparation such as Norethisterone 5 mg TDS. The ‘standard’ protocols are not always suitable for every patient, and every treatment regime should be tailored according to the patient's medical history and response to any previous ovarian stimulation.