- Down regulation cycle
Flare cycle
Clomid / FSH cycle
FSH and GnRH antagonist cycle
Clomid or Natural cycle
How do doctors choose treatments?
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botheration
- Newbie
- Posts: 17
- Joined: Mon Oct 01, 2007 7:08 am
How do doctors choose treatments?
My clinic offers five different IVF treatment cycles:
Me: 39
Him indoors: 37, wonky sperm
TTC for ages
ICSI #1 Sept 07: Cancelled because I only made one mature follicle
ICSI #2: two eggs (ok, I'm a poor responder!), one fertislise and on board, beta 14/11
Him indoors: 37, wonky sperm
TTC for ages
ICSI #1 Sept 07: Cancelled because I only made one mature follicle
ICSI #2: two eggs (ok, I'm a poor responder!), one fertislise and on board, beta 14/11
Hi Botheration,
It's based on a number of factors including your age, your various test results, how you did on a previous cycle, etc. That's why there's so much testing prior to starting.
For example, most clinics have written protocals in place that if you meet criteria A,B,C then they try Cycle X or if you meet criteria D,E,F then they try Cycle Y. They may not tell patients all the protocals because really until you go through that particular cycle it's information overload.
I believe the Down regulation cycle is what they try first for women who are younger & with fairly normal test results. I think Flare is probably for woman that they think the Lupron will shut down the ovaries too much. I'm not sure about the Clomid cycles.
If I've gotten any of this wrong, someone else please feel free to jump in & correct. Ghost, are out there?
2ndtimer
It's based on a number of factors including your age, your various test results, how you did on a previous cycle, etc. That's why there's so much testing prior to starting.
For example, most clinics have written protocals in place that if you meet criteria A,B,C then they try Cycle X or if you meet criteria D,E,F then they try Cycle Y. They may not tell patients all the protocals because really until you go through that particular cycle it's information overload.
I believe the Down regulation cycle is what they try first for women who are younger & with fairly normal test results. I think Flare is probably for woman that they think the Lupron will shut down the ovaries too much. I'm not sure about the Clomid cycles.
If I've gotten any of this wrong, someone else please feel free to jump in & correct. Ghost, are out there?
2ndtimer
2ndtimer is correct.
At most clinics, they will start with a "long Lupron" protocol. These are around 80% of cycles in the US. Most cycles worldwide are similar, although they might substitute some other GnRH agonist for the Lupron (there are many similar drugs).
The next most common are the GnRH antagonist cycles. Some say these are a little less successful than the usual agonist cycles (like Long Lupron cycles), but others say that difference is only because there is less experience with antagonists (they are newer than agonists).
One big advantage with antagonist cycles is that you are not forced to trigger with hCG. This is important for safety in high responders who are at risk of OHSS. You can use a GnRH agonist (Lupron) to trigger an LH surge instead of using hCG, but this will obviously not work if Lupron is already being used for down regulation. With the Lupron trigger, you get a surge of natural LH to mature the eggs. The LH vanishes quickly, unlike hCG, so the chance of OHSS is greatly reduced.
The flare cycles are rare but becoming more frequent. They are usually used after one or both of the other protocols failed in prior cycles. Flare cycles take advantage of the initial "flare" in LH and FSH levels right after the Lupron is started. They time this so that it jump starts ovarian stimulation.
We don't do the natural cycle IVF, but some clinics do.
At most clinics, they will start with a "long Lupron" protocol. These are around 80% of cycles in the US. Most cycles worldwide are similar, although they might substitute some other GnRH agonist for the Lupron (there are many similar drugs).
The next most common are the GnRH antagonist cycles. Some say these are a little less successful than the usual agonist cycles (like Long Lupron cycles), but others say that difference is only because there is less experience with antagonists (they are newer than agonists).
One big advantage with antagonist cycles is that you are not forced to trigger with hCG. This is important for safety in high responders who are at risk of OHSS. You can use a GnRH agonist (Lupron) to trigger an LH surge instead of using hCG, but this will obviously not work if Lupron is already being used for down regulation. With the Lupron trigger, you get a surge of natural LH to mature the eggs. The LH vanishes quickly, unlike hCG, so the chance of OHSS is greatly reduced.
The flare cycles are rare but becoming more frequent. They are usually used after one or both of the other protocols failed in prior cycles. Flare cycles take advantage of the initial "flare" in LH and FSH levels right after the Lupron is started. They time this so that it jump starts ovarian stimulation.
We don't do the natural cycle IVF, but some clinics do.