Standard eco protocol. What is long IVF protocol

The in vitro fertilization procedure involves the use of one or another combination of medical actions that ensure the onset physiological pregnancy through assistive technologies.

Entering the IVF protocol involves a number of special steps that prepare the female body for the implantation of a fertilized egg. Preparation is carried out with the help of hormonal effects on the patient's body and other secondary methods. The main stages of entry will be considered using the example of long and short in vitro fertilization protocols.

Depending on the woman's gynecological history and the presence of concomitant pathologies, medical specialists reproductologists select an individual type of in vitro fertilization protocol for each patient. As indications for the implementation of a short protocol, there are:

Previous attempts to implement one of the IVF protocols that were unsuccessful;
The patient has no pathologies of the pelvic organs and problems with ovulation.

The long IVF protocol has the following list of indications for implementation:

Previously failed fertilization episodes;
Primary IVF in a patient who does not have functional and organic pathologies of the organs of the reproductive system;
Uterine fibroids, endometriosis and other hyperplastic processes in the mucosa.

Short

Before you learn about entering the IVF protocol and what it is, each patient will need to prepare the body for this serious intervention. First of all, lifestyle modifications are recommended, and complete failure from bad habits at least 90 days before the start of the IVF protocol.

The next step is to examine the body, both the future mother and the future father. couple recommend doing a series laboratory research and ultrasound examination organs of the reproductive system.

Many patients who are preparing to enter into one of the IVF protocols are prescribed Inofert. This pharmaceutical drug contains folic acid, which reduces the likelihood of anomalies in the development of the neural tube in the unborn fetus. D

The duration of taking Inofert before entering the IVF protocol is at least 90 days. If a woman has problems with the structural and functional state of the endometrium, then reproductive specialists prescribe her a course of therapy with Norkulit.

Only if 100% complete female body to the process of hormonal stimulation and implantation of fertilized eggs, reproductologists begin the consistent implementation of one of the in vitro fertilization protocols.

A short IVF protocol has the following schematic form:

In the period from 2 to 12 days of the ovarian-menstrual cycle, the patient is prescribed hormonal stimulation of the body, the duration of which is about 14 days. To implement a short protocol, as a rule, a small amount of stimulant drugs is used. At the same time, reproductive specialists are laboratory control hormonal background women;
From the 15th to the 20th day of the ovarian-menstrual cycle, the seminal fluid of the potential father is donated for laboratory analysis for quantitative and qualitative indicators, as well as puncture of the follicle of the expectant mother. The duration of the procedure for extracting female germ cells is no more than 40 minutes;
From the 18th to the 23rd day of the ovarian-menstrual cycle, fertilization of previously taken female germ cells is performed. The duration of this period is from 3 to 5 days;
From 22 to 28 days of the ovarian-menstrual cycle. The specified time period is used for the implantation of ready fertilized eggs into the uterine cavity of future mothers.

In order to control the effectiveness of the implemented in vitro fertilization protocol, on the 6th day from the moment of implantation of the zygote, the patient undergoes control test for pregnancy.

The average duration of the implementation of a short in vitro fertilization protocol from the moment of entry into it is 45 days. Since this type of IVF algorithm involves the use of minimal dosages of drugs, the patient is not at risk of such side effect like ovarian hyperstimulation. After it happened successful implantation of the finished embryo, in order to support it in the conditions of the mucous membrane of the uterine cavity, are used medicinal medicines based on progesterone.

Long

In order to fully implement this kind of in vitro fertilization algorithms, more than one ovarian-menstrual cycle is required. After completing the preliminary preparation of the female body and successfully passing the laboratory and instrumental methods research, on the 21st day of the cycle, a woman enters long protocol ECO.

This procedure is characterized by the stage of inhibition of its own hormones in the female body, which allows you to control the process of egg maturation. In order to understand the specifics of this type of assisted reproductive techniques, it is necessary to familiarize yourself with its phased implementation:

The start of the IVF protocol occurs from the 21st to the 3rd day of the next ovarian-menstrual cycle. During this period, drug blockade of pituitary functions is carried out. The duration of this stage is from 12 to 15 days;
3rd to 17th day of the cycle. During this period, the female body undergoes hormonal stimulation of the ovaries. The duration of the stage is from 2 to 3 weeks;
36 hours before the follicle puncture, the patient is given an injection of hCG;
From the 17th to the 20th day of the ovarian-menstrual cycle, semen is taken from the future father for analysis, as well as the puncture of the finished follicles;
From the 20th to the 25th day of the cycle, medical specialists perform the fertilization of the taken eggs and monitor their condition;
From the 25th to the 27th day of the cycle, the implantation of the finished zygotes into the uterine cavity of the woman is performed.

The implantation phase is followed by a period of enhanced maintenance hormone therapy during which progesterone is used. Aim this stage is to ensure favorable conditions to attach the finished embryo to the uterine endometrium. The duration of maintenance therapy is 14 days.

The successful entry and implementation of a long in vitro fertilization protocol can only be judged on the condition that 12-14 days after the end of the procedure, the woman received positive test for pregnancy.

The reproductive specialist who is responsible for the implementation of this procedure will tell you in detail about the day of the cycle from which the IVF protocol begins.

And stimulated cycles and so on. It is impossible to say which one is better. The choice of one of the stimulation schemes pursues certain goals and is assigned based on the indications and interests of patients. All types of stimulation protocols consist of 4 stages.

The general simplified scheme of the IVF protocol
General rules
Dose adjustment
Ovulation Triggers in the Stimulation Cycle
Scheme of a short IVF protocol
Super long protocol
IVF protocols with antagonists
IVF Protocol with Diferelin
Low AMH Protocols

Protocol with minimal stimulation

conclusions

The IVF program includes the following steps:

superovulation stimulation protocol;
ovarian puncture;
- embryo transfer;
luteal phase support.

Women tend to "try on" other people's schemes "for themselves" on the forums, choose a "winning protocol", which is a thankless task. Health problems, causes of infertility, comorbidities Everyone's sensitivity to medications is different. Successful prescribing regimen for one woman with big share probabilities can be a failure for another.

In order to understand the principle of appointment drugs in IVF protocols, you need to familiarize yourself with physiological mechanisms ovulation and egg maturation.

Physiological mechanism of egg maturation

Gonadotropins and releasing hormone are produced in the brain (in the hypothalamus), which signals the hypothalamus to release or stop the synthesis of follicle-stimulating (FSH), luteinizing (LH) hormones. In response, follicles begin to grow in the ovaries.

What are stimulation schemes designed for?

In vitro fertilization programs are designed to block the production of "their" hormones LH and FSH. Against the background of a complete or partial blockade, analogues are prescribed - preparations of these hormones in doses that are selected individually. IVF protocol schemes(with the exception of fertilization in natural cycles) are calculated so that the ovaries mature optimal amount follicles. On average 10-15.

General rules

For IVF protocols there are general principles which are strictly required. Prescribed medications are injectables. Injections (shots) will have to be administered subcutaneously (in the stomach) or intramuscularly (in the buttock). They should be done at the same time every day.

You can't on your own:

change the drug
increase the dose
reduce the dose
skip the introduction of the drug;
give an injection at another time;
cancel the drug.

The doctor has the right to adjust the regimen of prescribed drugs based on ultrasound. Ultrasound during stimulation is done 3-4 times.

Dose adjustment

In IVF protocols, the rule is used: per day, the diameter of the follicle should add 2 mm, the endometrium - 1 mm. Compliance is monitored by ultrasound. If they are violated, corrects appointments.

Ovulation Triggers

As soon as the bulk of the follicles reaches 18–20 mm, a drug is prescribed that triggers the mechanisms of egg maturation. The oocyte should “break away” from the wall of the follicle and be freely located in the follicular fluid. Preparations Ovitrel, Pregnil act as a trigger - a trigger. They modulate the conditions that occur against the background of a peak LH concentration, at which the oocyte detaches from the wall. After that, it becomes possible to successfully and "get" the egg.

Scheme of a short IVF protocol

Short protocol IVF corresponds physiological cycle and takes 4 weeks. Regulatory and stimulating drugs are prescribed simultaneously on the 2nd-3rd day of the cycle after the ultrasound examination.

Stimulation takes 10 days. Doses are selected individually. Ovulation triggers are assigned when the follicles reach required sizes. After 35 hours, a puncture is performed.

Advantages of the IVF short protocol scheme:

lower dose hormonal drugs;
good tolerance;
decrease in the likelihood of OHSS manifestations - .

Often a short protocol scheme is used in repeat programs after a long pacing protocol (if a satisfactory ovarian response to pacing has not been obtained).

Features of the long IVF protocol

Not everyone is suitable for a long protocol. The program is indicated for women with an average ovarian reserve, with, cystic changes in the ovaries, The choice in favor of a long scheme of stimulation is made with a low quality of eggs obtained earlier in a short protocol.

Advantages of the IVF long protocol scheme:

Synchronous development of follicles. They come out the same size.
Less percentage of immature eggs.

In contrast to the short protocol, the long scheme of stimulation is characterized by increased risk for women with a very rich ovarian reserve.

Scheme of the long IVF protocol is prescribed from the second phase of the cycle to 21-22 days. First, the drugs Diferelin, Decapeptyl are introduced and menstruation is waited. Against the background of these drugs, starting from the 2-3rd day of menstruation, stimulating drugs are prescribed - Puregon, Menopur, Gonal F or analogues for 10-12 days (sometimes longer). Ultrasound control is repeated 3-4 times.

Super long IVF protocol

Super long IVF protocol very similar to a long stimulation circuit. A significant difference is that Diferelin and Decapeptyl are prescribed in the form of a depot form and are administered once every 28 days. Maximum amount injections - 6. That is, a super-long protocol can last up to 6 months. Against this background, there is a decrease in previously punctured, a decrease in borderline. As soon as the doctor sees positive changes, against the background of these medicines stimulated scheme.

IVF protocols with antagonists

IVF protocol with antagonists– reserve, designed for women with low AMH – with a significantly reduced ovarian reserve, from an older reproductive age group, with a poor response to stimulation.

A feature of the protocol is that from the 2nd or 3rd day of the cycle, stimulating drugs are prescribed immediately. This causes a more productive ovarian response. The duration of stimulation is 8 days. On the 5th day, an ultrasound is done. Follicles are expected to grow up to 13–14 mm. After that, antagonist drugs are prescribed that regulate the functioning of the pituitary gland. Antagonists - Orgalutran, Cetrotide - prevent premature spontaneous ovulation. As in the other protocols, a trigger is assigned, and after 35 hours the ovaries are punctured.

IVF Protocol with Diferelin

The IVF protocol with antagonists is suitable for women with a rich ovarian reserve. In this case, Diphereline is used as a trigger. HCG preparations used as triggers for oocyte maturation stimulate development. Diphereline in the IVF protocol reduces the risk of overstimulation. The body of a woman “enters” the syndrome more slowly and is not so difficult, which allows to reduce the percentage of severe and medium degree severity of hyperstimulation syndrome.

For controlled stimulation in antagonist protocols, depot FSH preparations, such as Elonva, can be used. The dose is calculated by weight. The injection is done 1 time in 6-7 days, which reduces the number of injections in the protocol.

Low AMH Protocols

There are 2 types of IVF protocols designed for women with a low ovarian reserve - a protocol in a modified cycle (Shanghai) and a French protocol.

Protocol in modified cycle

This type of IVF protocol is designed for women in whom high doses of stimulant drugs cause only one follicle to grow. It makes no sense to prescribe stimulation when the ovarian response is manifested by the maturation of one oocyte.

For women with a poor ovarian reserve, this is the best IVF protocol:

financial costs are reduced;
the risk of cancellation of stimulation is reduced;
increase the chances of pregnancy.

Stimulation is initiated from the moment the follicle reaches a diameter of 10–12 mm. Use minimal doses of gonadotropins. Follicles grow up to 14 mm. After that, antagonists and an ovulation trigger are included in the scheme (with a follicle diameter of 18 mm). In this scheme, the probability of premature spontaneous ovulation increased.

For french IVF protocol characterized by similarity with a long protocol. The difference is that regulatory drugs are prescribed from 19–21 days of the cycle in minimum doses, due to which the pituitary gland is partially blocked. This allows for the induction of ovulation to use lower dosages of hormones.

The advantages of the French protocol are the same as those of the long one:

uniform growth of follicles;
higher percentage of full-fledged oocytes.

The disadvantage is the possibility of premature ovulation.

IVF protocol with minimal stimulation

Protocol scheme with minimal stimulation:

From the 3rd day of the cycle, Clomiphene citrate is prescribed.
From 8 - urinary gonadotropins are added, for example, Menopur. The medicine is administered every other day in an individual dosage.

Clomiphene citrate acts as a stimulant and prevents spontaneous ovulation. Along with this, the drug inhibits the growth of the endometrium. Therefore, the purpose of this protocol is to collect oocytes, fertilize them and cryopreserve or freeze unfertilized eggs. The transfer will take place in the following favorable cycles, while accumulating enough embryos for transfer.

Cryoprotocols can be of two types: natural cycle or against the background of drug preparation of the endometrium. Ovulation induction is not performed.

conclusions

The presented schemes types of IVF protocols have their own characteristics, advantages, indications. Which IVF protocol is better to prescribe is up to your reproductologist to decide.

In vitro fertilization or IVF is a procedure that involves taking an egg from a woman and fertilizing it in a special dish, followed by placing the embryo in the woman's uterus.

There are several IVF protocols that involve different preparation for puncture and embryo transfer. Depending on the condition of the woman, the doctor may prescribe a long or short protocol. The latter is more gentle for the female body, consider how it goes.

Definition

Short protocol IVF is a program in which a woman takes hormonal drugs for only two weeks. The duration of the short protocol is no more than one menstrual cycle.

The main advantage of a short protocol over a long protocol is the need to take drugs in smaller quantities. Therefore, IVF is easily tolerated by women, and the cost of the procedure is lower.

But, unfortunately, the short protocol is not suitable for every woman. For patients with pathologies of the uterus and ovaries, the absence of ovulation, and over the age of 35, such a protocol is most likely not suitable.

In addition, in a short protocol, the doctor cannot affect the condition of the follicles and endometrium of the uterus, so the likelihood of pregnancy after replanting is low. With a short protocol, there is a high risk of spontaneous ovulation, in which case the procedure will have to be repeated in next cycle.

Stages

A short IVF protocol begins with preparation. For this, a woman undergoes an examination by a gynecologist, a therapist, passes a general and biochemical analysis blood, as well as tests for HIV, syphilis, hepatitis and other infections. A woman must definitely undergo fluorography, ultrasound of the mammary glands and thyroid gland. If everything is in order, then prescribe medication.

Consider a short IVF protocol by day in detail:

From the 3rd day of the menstrual cycle, gonadotropin-releasing hormone (GnRH) agonists are prescribed. These drugs act on the pituitary gland and cause ovulation to stop.
The next stage of the short IVF protocol is prescribed follicle-stimulating and luteinizing hormone, which provoke ovarian superovulation. The duration of taking hormones is an average of 2 weeks.
The next step is to puncture the eggs and donate the husband's sperm, after which they are fertilized for 3-5 days, keeping them in favorable conditions.
36 hours before the embryo transfer, the woman is given an injection of the hormone hCG to support the pregnancy.
The next step is to transfer the embryos into the uterus.
The protocol ends with the intake of drugs that support pregnancy.

The result of a short IVF protocol can be seen approximately 2 weeks after embryo transfer. To do this, a woman can do a pharmacy pregnancy test, or take an analysis for the level of hCG. Now you know how long the short IVF protocol lasts.

The word "short" does not imply a reduction in the duration of ovarian stimulation, but the absence of a preliminary stage of preparing a woman before starting the procedure. Short scheme stimulation adjusts to the natural monthly cycle, starts from 2-3 days from the onset of menstruation and lasts an average of 12-15 days, total length Protocol about 25-32 days. The "long" protocol is so called because of the additional step of taking certain drugs, starting from the previous cycle. Its length is about 40 days. There are other types of protocols: super long, ultra short, and so on.

Indications for short and long IVF protocol

Indications for a short IVF protocol

a healthy woman with a regular menstrual cycle and a good supply of eggs;
unsuccessful IVF attempts using other types of protocols;
financial considerations, because a short protocol is much cheaper than a long one.

Indications for a long IVF protocol

the so-called "standard" patient, that is, a woman without any health features and the menstrual cycle, who came to the first IVF attempt;
older women with low egg reserves on ultrasound and anti-Müllerian hormone;
women with endometriosis, endometrial hyperplasia or uterine fibroids;
patients with failures in other types of protocols.

Usually, a long protocol is chosen for the first attempt at reproduction, but any other options are possible at the discretion of the doctor.

Scheme of short and long IVF protocol by day

The general scheme and sequence of drugs are identical for all protocols, only the preliminary preparation of the woman, the dose and duration of taking the drugs differ. AT in general terms Let's outline the short protocol:

The scheme will be adjusted to the patient's own menstrual cycle. From 2-3 days, you will start taking gonadotropin-releasing hormone agonists. Reception continues until ovulation.
The day after the first injection of GnRH, they begin taking stimulant drugs - FSH analogues, which will make the eggs ripen. Continue the introduction of stimulants for 14-20 days.
When the follicles reach 18 mm in size, the drug is injected chorionic gonadotropin(hCG), which induces stimulation.
Within 36 hours later hCG injection puncture follicles. Simultaneously with the puncture of the eggs, the husband donates sperm.
The resulting eggs and sperm are combined in a test tube on a special medium. When sedentary spermatozoa fertilization occurs by ICSI, when the sperm is injected directly into the egg with the thinnest needle under the control of ultra-powerful microscopes.
Within 2-4 days, the resulting embryos grow, they are checked for genetic abnormalities and prepared for implantation (replanting).
As a result, on the 16-20th day of the cycle, the grown embryos are planted in the uterine cavity. After that, the next stage of drug support begins - the luteal phase.
Simultaneously with the replanting of embryos, progesterone preparations are started: natural or synthetic.
Approximately on days 26-32 of the protocol, a test for the content of hCG can be performed. When positive result continue taking progesterone.

As already mentioned, the long protocol is distinguished by the presence of an additional stage. This scheme starts menstrual cycle prior to superovulation. From about 20-21 days, the woman begins to inject GnRH injections, continuing until ovulation. Thus, the protocol itself will take about 40 days, the stimulation itself with FSH preparations varies in duration within 15-20 days. The rest of the scheme is similar to the short protocol.

Drugs in IVF protocols

Let's talk more about medical preparations used in the protocol.

Gonadotropin-releasing hormone agonists (Diferelin, Buserelin, Triptorelin). Their mechanism of action is extremely complex, in short, the drug works like this: agonists are similar in structure to the natural gonadotropic hormones of the pituitary gland. However, the rate at which agonists occupy receptors is faster compared to natural hormones.

Thus, the drug takes the place of its gonadotropic hormones. The function of the pituitary gland fades away, the woman enters the so-called "artificial menopause". The ovaries, endometrium, mammary glands are in a dormant state. In the long protocol, this action is used as a warning of early or spontaneous uncontrolled ovulation. In super-long - for the treatment of fibroids and other hormone-dependent diseases of the female genital area.

GnRH preparations are available as injections and nasal sprays. Injections are preferred, as they are administered once a day, in contrast to nasal forms, which are administered 2-6 times a day.

ovulation stimulants. These drugs, against the background of sleeping ovaries, stimulate the formation of several follicles in them. To stimulate multiple ovulation (superovulation), IVF protocols use drugs based on follicle-stimulating hormone (FSH): recombinant or highly purified urinary (Puregon, Profazi, Horagon). It is necessary to introduce stimulants under strict control of the level of estradiol or ultrasound - control to prevent dangerous complication stimulation-syndrome hyperstimulated ovaries.
ovulation inducer. In order to force the mature follicle to covulate and form the luteal phase of the cycle, an injection of hCG is used (,).
Progesterone preparations: natural (Utrogestan, Crinon, Susten and others) or synthetic (Dufaston). They exist in the form of capsules, suppositories, gels, creams and tablets. Most often, their use is continued after the onset of pregnancy with a gradual withdrawal after 16 weeks.

The short protocol has its pros and cons. Of the obvious advantages can be called:

Circuit speed. The entire cycle takes no more than 32 days, unlike the long protocol, which lasts about 40-45 days;
Cheapness. Due to the shortening of the scheme, fewer expensive drugs are used;
Less likely;
Easy portability of the protocol by a woman.

Disadvantages of the short version:

Frequent possibility of spontaneous uncontrolled ovulation due to the short duration of GnRH use;
Insufficient quantity or quality of follicles obtained.

The long scheme is also imperfect, but it is she who is the oldest, proven and recommended for the first IVF attempt.

Advantages:

Good ovulation control, with no ovulatory bursts;
A large number of mature and full-fledged oocytes;
Possibility of use in older patients with poor ovarian reserve.

Flaws:

Pronounced drug load on the body, as well as side effects GnRH similar to manifestations;
high cost;
The real possibility of getting complications in the form of ovarian hyperstimulation syndrome due to more long-term use FSH analogues.

Having decided to have a child with the help of IVF reproductive technology, spouses are faced with a mass of new and incomprehensible terms. And there is no exception here such a thing as IVF protocols.

What is the IVF protocol?

IVF protocols are sequencing schemes for the introduction of special drugs and other manipulations that can be selected individually for each woman, depending on the state of health, age and other factors. Standard scheme The IVF protocol is as follows: superovulation stimulation, follicle puncture, embryo transfer, progesterone support, hCG control analysis.

What are IVF protocols?

The IVF protocol is stimulated and natural. The two main varieties of stimulated IVF protocols are short and long protocols. Also known are the Japanese IVF protocol, the natural cycle protocol, the cryoprotocol.

Long IVF protocol

The long protocol is considered standard. This protocol is the longest among all known protocols - longer than 5 weeks, or 40-50 days. It is characterized by complete control of the hormonal background during the protocol. As a result, the maximum possible number of eggs can be obtained - up to 20 pieces.

As you know, the success of IVF directly depends not only on the quantity, but also on the quality of the retrieved eggs. The maturation of high-quality eggs, in turn, depends on a properly selected scheme for stimulating superovulation. In this sense, a long protocol is considered more reliable.

Indications for the appointment of a long protocol may be endometriosis, fibroids, hyperandrogenism, overweight body.

Also, a long protocol can be prescribed if it was preceded by a short one, in which it was not possible to obtain eggs of the desired quality.

Begins long IVF protocol on the 21st-25th day of the cycle, about a week before menstruation. First of all, with the help of GnRH agonist drugs (buserelin, diferelin, etc.), the function of one’s own hormonal regulation female body so that doctors can control the ovaries. Agonists block the natural work of the ovaries and pituitary gland, are prescribed for a period of 12-22 days. This is the regulatory phase of the protocol.

The next phase - stimulating, begins on the 3rd-5th day of the next cycle. Within 10-17 days, it is necessary to take gonadotropins (puregon, pregnil, etc.), which cause the growth of many follicles and the maturation of eggs in them. When the follicles reach preovulatory sizes, the doctor prescribes ovulation trigger drugs for the final maturation of the eggs - usually these are chorionic gonadotropin (hCG) drugs.

The puncture of the follicles takes place on the 12-22nd day of the cycle, and after 3-5 days - the transfer of embryos. This is followed by support with progesterone preparations up to the control positive analysis for pregnancy.

The disadvantage of a long protocol is the risk of developing ovarian hyperstimulation, the consequences of which can be very serious. The main advantage lies in full control over simultaneous maturation a large number follicles and endometrial growth due to artificial hormonal control of these processes from the outside.

Short protocol IVF

The short protocol starts on the 3rd day of the menstrual cycle immediately with the stimulation phase. It differs from the long one in the absence of a regulatory phase, and as a result, a smaller number of follicles mature in it, the eggs may be of lower quality and unequally mature.

Despite the fact that there is no regulatory phase in the short protocol, pituitary blockers are prescribed from the very beginning of the protocol until the follicle puncture, but at a lower dose than with the long protocol, then on day 3-5 of the cycle, gonadotropins are taken for 10-17 days , after which the final preparation of the follicles for ovulation is triggered by hCG preparations. The puncture of the follicles occurs on the 14-20th day of the cycle. And then - everything is like in a long protocol.

The short protocol is suitable for women with healthy ovaries, it is prescribed for older women, as well as for those who have already had a long protocol, unsuccessful in the quality and quantity of eggs taken, and for other special indications.

The advantages of the short protocol are shorter - about 4 weeks, or 28-35 days, which leads to a reduced risk of developing ovarian hyperstimulation and easier tolerability of the whole process. Cons - in a smaller number of equally maturing eggs good quality and in the likelihood of spontaneous ovulation.

The variety is ultrashort protocol. Instead of GnRH agonists, antagonists are used here, due to which the likelihood of premature ovulation is significantly reduced, follicle puncture is performed already on the 10-14th day.

Japanese IVF protocol or Teramoto protocol

This protocol is characterized by minimal ovarian stimulation with low doses of drugs. Main principle- it is not the quantity that matters, but the quality of the eggs. The resulting embryos are often subjected to cryopreservation, and in the next cycle, defrosting and transfer.

The careful nature of the Japanese protocol avoids possible complications from taking hormones as much as possible.

IVF protocol in natural cycle

The natural protocol does not involve the use of any hormonal drugs to stimulate ovulation. Everything happens in the usual way - the egg matures on its own, as it happens in a normal menstrual cycle. In order to correctly calculate the time of follicle puncture, the doctor needs great skill.

The maturation process is monitored by ultrasound monitoring. This is followed by all other phases inherent in most of the protocols, namely puncture and transfer. Support is usually not required.

The only, but very significant drawback of such a protocol is that the probability of losing an egg is quite high, since natural ovulation is beyond control and can occur before the date of puncture. Dignity - in the absolute naturalness and the absence of many medicines.

As you can see, IVF protocols are very diverse. It is up to the doctor to choose the most appropriate protocol, spouses cannot choose on their own. Of course, in each specific case, if it is important, the material possibilities of the couple can be taken into account. For example, Japanese, ultrashort and natural protocols are less expensive in terms of finances compared to other types of protocols, which is associated with fewer necessary drugs. It is important to be sure that the selected reproductologist has sufficient qualifications to individual approach, which will allow him to choose the optimal protocol and calculate the risks of complications.