Controlled Ovarian Stimulation
F. Antagonist Protocol
The antagonist protocol is used in patients at high risk for developing severe OHSS (How To Avoid OHSS) and it may or may not follow a pre-treatment with oral contraceptives. The antagonist medication is added to FSH after 5-6 days and continued until the trigger injection. In patient with very prolific ovarian response leuprolide can be used for the trigger injection in place of the standard hCG bolus, thus reducing the risk of ovarian hyper-stimulation syndrome.
G. Flare Protocol
The flare protocol is used in patients with reduced ovarian reserve and in patients who have previously failed to respond to the long or antagonist protocols. It takes advantage of the initial stimulatory effect of leuprolide which results in release of FSH and LH from the pituitary gland before inducing suppression. This protocol usually follows a pretreatment with oral contraceptives. Micro-dose leuprolide injections are given twice per day starting 3 days after the last pill and two days later high-dose FSH injections are added. As in the long protocol, hCG must be used for the trigger injection.