At the Center for Fertility and Gynecology in Los Angeles, our IVF program is amongst the most successful in the nation. (In 2010, some of our selected patient populations enjoyed live birth rates of up to 76.9%! Despite being extremely proud of this accomplishment, we continually strive to do even better. Through constant self-monitoring, quality control measures, continuing education and active research our center is poised to remain a leader in the treatment of infertility.
One specific reason for our success is the utilization of individualized treatment plans. From tailored medication dosing, to flexible appointment times and personally adjusted treatment protocols, our patient centered approach is evident in all that we do.
Speaking of protocols, the doctors at the Center for Fertility and Gynecology expend great effort to determine the appropriate IVF protocol for each patient. The following is a description of one of our most common protocols.
The long protocol is one of original types of protocols used at the Center for Fertility and Gynecology. It is often the first protocol used when a new patient starts IVF. The long protocol is good for many younger patients or those with strong ovarian reserve. It is called the long protocol because it necessitates the longest amount of time on luprolide acetate.
Luprolide acetate, known by the brand name Lupron, is a medication which ultimately stops hormonal communication between the brain and the ovary. This effect is desirable because the natural patterns of hormone communication between the brain and ovary work counter to our goals in an IVF cycle. During a natural menstrual cycle, the brain normally coaxes one egg to grow within the ovary per month. During an IVF cycle however, we want several eggs to grow at the same time. Secondly, during a natural menstrual cycle the brain monitors the growth of the egg and sends a signal for that egg to ovulate when it reaches a particular size. During IVF, we want to prevent the brain’s ovulation signal. This way, we can supply the ovulation signal and thus be present to retrieve the eggs. For these reasons, Lupron is used in the long protocol.
Lupron is a daily injection which is started after the patient has taken birth control pills for a couple of weeks (or about a week before the period is expected to begin if the patient is not on birth control pills). After taking Lupron for about a week, the patient will get her period and be ready to start the next phase of the cycle, the stimulation.
The stimulation involves injections of 2 more medications in addition to lupron. These medications are hormones called gonadotropins. They are the same hormones produced by the brain to stimulate egg growth in the ovary. In the IVF setting, gonadotropins are provided in a dose designed to stimulate multiple eggs to grow. The dose is adjusted based upon how many and how fast the eggs are responding. In addition to the Lupron, the stimulation medications are taken daily for roughly 8-10 days. During this time, the ovaries are monitored very closely with frequent ultrasound examinations and blood draws for estrogen levels. Once it is determined that the eggs are ready, an injection of another hormone called HCG is prescribed. The HCG induces the final steps of egg maturation and allows the doctor to retrieve the egg from the ovary.
In general, the long protocol takes between 17 and 21 days from the time that Lupron is started until the eggs are retrieved. During this time, most patients have 6-8 visits with their doctor.
If you have questions about IVF protocols or about fertility treatment in general, feel free to contact one of our fertility specialists at (818) 881-9800