1) Long protocol
21 days into the cycle (regular 28 days cycle) the woman starts GnRH agonists (Arvekap 0.1mg) daily for down-regulation and after the period we add daily injections of gonadotrophins. During ovarian stimulation, we examine the woman with vaginal ultrasound every 2-3 days and estradiol levels if necessary. When at least 3 follicles reach 17-18mm the woman receives an hcg injection and after 34-36h we collect the eggs with oocyte retrieval.
2) Short protocol
From day 2 of the cycle, the woman starts daily injections of GnRH agonists and from day 3 starts daily injections of gonadotrophins . This protocol is shorter and lasts 10-13 days depending on the response of the ovaries.
3) GNRH antagonists protocol
From day 2-3, the woman starts daily injections of gonadotrophins and on day 5-6 of the stimulation or when the largest follicle reaches 12mm we add GnRH antagonists. This protocol also lasts 10-13 days.
4) Combined protocol with clomiphene citrate or letrozole and gonadotrophins.
From day 2 the woman starts clomiphene citrate or letrozole daily for 5 days.From day 3 she starts daily injections of gonadotrophins and when the largest follicle reach 17-18mm she receives HCG injection.
5) Natural cycle
In the natural cycle, the purpose is to collect the egg which the woman produces by herself without the aid of hormones. The natural cycle is an alternative for young women who don’t want to receive hormones and for poor responders or women over 38 where the best approach is to collect the resulting embryos and freeze them till we have at least 2-3 good quality embryos to transfer in the uterus (depending on the woman’s age). The success rates of the collect and freeze approach are very good.
