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Stimulation Protocols


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Every treatment protocol is customized according to your needs and your doctor will be able to advise you as to which protocol is suitable for you. There is no standard protocol for ALL patients, as every patient is different.

Your doctor will choose a protocol that best suits you, that gives the least discomfort and has the shortest duration, yet accords you the highest chance of success.

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Long Down Regulation Protocol (LDR)

This is one of the protocols that is employed in Sunfert. The suppressive effects of the initial injections (busereline) seem to be beneficial for women with endometriosis which sometimes can be undiagnosed. Studies have shown that success rates with LDR protocol are marginally better than other protocols.

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Long Down Regulation Protocol Treatment Timeline
  • First visit to the clinic is roughly about a week before the onset of your menses (usually Day 21 of your menstrual cycle).
  • During this visit, you will undergo a scan to confirm that you have ovulated.
  • Sometimes, your doctor may have given you some oral contraceptive pills (OCPs) from the beginning of your menstrual cycle (usually Day 2 or Day 3) and you commence injections on your own a few days before the last pill.
  • The first type of injection is called Buserelin (Suprefact) and is given as a daily dose in the morning before you go about your usual daily activities.
Good to know:
  • These injections are well tolerated, though sometimes the patient may have hot flushes.
  • You will still have a menstrual period though it may be lighter or prolonged.
  • After about 2 weeks of injections, you will be seen in the clinic for a repeat scan to confirm down regulation (ovaries that are quiet).
  • The dose of Buserelin is subsequently reduced and approximately a week later, you will commence stimulation of the ovaries.
  • This involves the use of a daily hormonal injection called FSH (Gonal F,Puregon or Menopur) for about 10 to 12 days.
  • The LDR protocol takes about 4 weeks plus in total.
  • A scan would be repeated on Day 5 of injections after which another injection called GnRH antagonist (Cetrotide or Orgalutran) is commenced.
  • This injection which is also done daily prevents premature release of the eggs. In total you will do about 10 to 12 days of injections
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'Short' GnRH Antagonist Protocol

This protocol is gaining prominence due to its shorter duration and is commonly employed in Sunfert. It is particularly useful in women with polycystic ovaries, as there is lower risk of ovarian hyperstimulation syndrome.

Your doctor may sometimes give you several days (up to 3 weeks) of OCPs from the onset of your menses. Then on the second or third day of your withdrawal menses after the pill, you commence the daily FSH injections immediately.

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'Short' GnRH Antagonist Protocol Treatment Timeline

A scan would be repeated on Day 5 of injections after which another injection called GnRH (Cetrotide or Orgalutran) is commenced. This injection which is also done daily prevents premature release of the eggs. In total you will do about 10 or 12 days of injections.

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Microflare Protocol

This protocol is reserved for older women, women with low ovarian reserve or who have responded poorly with previous protocols.


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Microflare Protocol Treatment Timeline

This protocol involves a pre-treatment with OCPs and subsequently a low dose busereline injection from Day 2 of menses, which acts to flare up the ovaries. You will subsequently be commenced on daily FSH injections from Day 3 onwards. The entire treatment protocol takes about 10 to 12 days.

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Natural Cycle IVF

Women with regular cycles but low ovarian reserve can opt for natural cycle IVF. These women will also very likely produce one or two eggs on their own or with a low dose of FSH stimulation. These eggs are easier to harvest and more likely to be better in quality and subsequently develop into an embryo. The advantage of this cycle is a reduction in cost and improved patient tolerability.

During the period of stimulation, you are expected to visit the clinic about 3 times. You are advised to carry on with your usual routine of work or house duties to minimize your stress levels. All injections are self-administered for your convenience, and our fertility nurse will teach you how to perform the injections. It is important to keep the injections in the refrigerator to preserve their effectiveness.

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The Biological Clock

This tool indicates:

  • Natural conception per month if you have no fertility issues
  • IVF success rate at the same age
  • When to seek help after months of unsuccessful attempts

If you are concerned at any stage – we recommend booking a doctor appointment or a free nurse consultation. The sooner you make a plan the better your chances in the long term.

When to seek advice early

  • If you have polycystic ovaries, endometriosis, or have been through a cancer diagnosis; we recommend you get in touch quickly so we can talk you through all your options and give you the greatest possible chance of success.
  • If you’re a single woman considering motherhood in the future; it’s best to approach us early and consider egg freezing as this can be an option for you while you have a higher ovarian reserve and healthier eggs.
Set your age and the months you’ve been trying to conceive
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Your chance of having a baby per month for fertile couples
Your chance of having a baby per IVF cycle (if experiencing infertility)

Body Mass Index calculator

Being overweight or underweight can reduce fertility, so it is important to keep your body weight within the normal healthy range.

Body Mass Index (BMI) is an indication of your body weight and can be calculated by dividing weight by height. You should aim for a BMI of between 20 and 25, as this will optimise your chances of conception.

Woman’s BMI below 19

Even in these modern times, nature knows best. If a woman's BMI falls below 19, the body senses famine and ovulation is switched off to prevent the risk of having a baby with malnutrition. Excessive exercise can reduce body fat and increase muscle mass to a point where periods cease for the same reason. Risk of miscarriage is also increased in women with a low BMI.

Being underweight

If a woman's BMI falls below 19, the body senses famine and ovulation is switched off to prevent the risk of having a baby with malnutrition. Excessive exercise can reduce body fat and increase muscle mass to a point where periods cease for the same reason. Risk of miscarriage is also increased in women with a low BMI.

BMI’s greater than 30

This can reduce fertility by 50%. Pregnancy for women with a 30+ BMI is often associated with problems such as maternal diabetes, high blood pressure, big babies and increased risk of caesarean section.

Add your height and weight to calculate your BMI