Superovulation

Superovulation

There are many ways of induction ovulation for IVF/ICSI. These techniques are called superovulation.  The following are the commonest protocols used in our clinic:

  1. D21 agonist protocol
  2. D2 agonist protocol
  3. Antagonist protocol

D21 agonist protocol

This protocol is usually done in women who have regular periods. A GnRH (gonadotrophin releasing hormone) agonist called Buserellin is started 7 days before the expected next menstrual cycle. In a woman who has a 28-day cycle it will fall on the 21st day of her previous menstrual cycle. 0.1 mls of buserellin are given in 2 divided doses 12 hours apart. You will be taught to self-administer this injection.

This injection is given until your next menses.

After about 10 days of this injection and you have had your menses, you will be seen in the clinic for an ultrasound and a blood test to ensue that you are downregulated. Down regulation means that your pituitary gland (located in the brain) is not producing any more FSH ( follicular stimulating hormone). 

You have been downregulated if

  • your ovaries do not have any large follicles
  • your endometrium is thin
  • blood tests shows a low oestrogen, progesterone and LH (luteinizing hormone) level.

Once you are downregulated, you will be started on a second injection calles FSH (follicle stimulating hormone). Your doctor will decide on the type and amount of injection.

You are required to continue with the buserellin injection when you start your second injection.

Your dosage of buserellin will be reduced to 0.05mls taken 2 times a day 12 hours apart.

After about 5 days of the FSH injection, you will be seen in the clinic for a blood test and ultrasound. Based on the results, you will continue with the same dose or he may increase or reduce the dose.

You will continue the injection for another 3 or more days. You will be seen 1 or more times for an ultrasound and blood test.

When the follicles reach 16 to 18mm in diameter and the blood hormone level are considered good, then you will be given an injection called HCG. This injection is given to induce ovulation. It is given at night and the time of the injection will depend on the time of oocyte recovery. Usually oocyte recovery is performed 34 to 36 hours after the HCG injection.

D2 agonist Protocol

This protocol is usually done in women who do not have regular periods. Blood tests are usually performed on the second day of the menses. Buserellin is then started on the second day of the periods. Daily 0.5mls of buserellin in used in this protocol. The injection is given for 14 days.

You will be seen in the clinic for an ultrasound and a blood test to ensue that you are downregulated.

Once you are downregulated, you will be started on a second injection namely FSH injection. Your doctor will decide on the type and amount of injection.

You are required to continue with the buserellin injection 0.5 mls daily when you start your second injection.

After about 5 days of the FSH injection, you will be seen in the clinic for a blood test and ultrasound. Based on the results, you will continue with the same dose of FSH or the doctor may increase or reduce the dose of FSH.

You will continue the injection for another 3 or more days. You will be seen 1 or more times for an ultrasound and blood test.

When the follicles reach 16 to 18mm in diameter and the blood hormone level are considered good, then you will be given an injection called HCG. This injection is given to induce ovulation. It is given at night and the time of the injection will depend on the time of oocyte recovery. Usually oocyte recovery is performed 34 to 36 hours after the HCG injection

Antagonist protocol

This protocol can be used for both patients with regular and irregular periods. Blood tests and a transvaginal ultrasound are done on the second day of the periods. You will be started on FSH injection immediately. You will be seen after 5 days of injection (on D6 of your menses). Blood tests and ultrasound is performed and based on the result you will be started on a second injection called an antagonist. This is also given by yourself subcutaneously. You will continue with the FSH injection. The dosage may remain the same of at times your doctor may increase or decrease it. After another 3 days of injections, you will be seen again for a blood test and an ultrasound.

When the follicles reach 16 to 18mm in diameter and the blood hormone level are considered good, then you will be given an injection called HCG. This injection is given to induce ovulation. It is given at night and the time of the injection will depend on the time of oocyte recovery. Usually oocyte recovery is performed 34 to 36 hours after the HCG injection