What Are IVF Protocols – Types and Differences

VF Protocol: What It Is and How to Choose the Right One

An IVF protocol is a mandatory part of the in vitro fertilization process. For many couples, it is the only chance to become happy parents. It involves a comprehensive methodology that includes several stages and serious preparation. The process begins with medical stimulation to promote egg maturation, followed by the retrieval of oocytes. Depending on the protocol, the entire procedure can take between 22 to 45 days and is recommended for various types of infertility.

Types of IVF Protocols

There are two main types of IVF protocols: long and short. The choice depends on the condition of the woman’s reproductive system. After examining the couple, the doctor selects the most appropriate protocol.

An IVF protocol is not just a set of guidelines and prescriptions to follow at will, but a clearly outlined plan that includes specific medications and procedures. Any deviation from the protocol may result in an ineffective outcome.

Short Protocol

This is the most commonly used protocol, as it aligns with the natural menstrual cycle and takes relatively little time.

It is suitable for women with:

• Polycystic ovary syndrome or blocked fallopian tubes

• Low ovarian reserve

The first stage is superovulation stimulation using hormonal therapy, typically starting on the 3rd day of the menstrual cycle. To suppress premature ovulation, antagonists are administered on the 5th–6th day (the dosage is calculated individually). The woman also takes gonadotropins, which stimulate follicular growth. Between days 14 and 20 from the start of menstruation, follicular puncture and embryo transfer are performed.

Features of the short protocol:

• Shorter duration (on average 25 days, hence the name)

• Minimal medication, reducing the overall cost

• Easily tolerated by most patients

• Lower risk of ovarian hyperstimulation

• Suitable for women of advanced reproductive age

• Effective in cases of male infertility

Long Protocol

The key feature of the long protocol is strict hormonal control by the physician. It begins on the 20th day of the menstrual cycle, and the process of maturing eggs takes about a month. The first phase involves suppressing the body’s natural hormone production, followed by stimulation of ovulation using gonadotropins.

The main advantage of the long protocol is the prevention of asynchronous follicular growth, which allows for the collection of uniformly high-quality eggs. This scheme is suitable for women who previously had poor-quality oocytes in a short protocol or suffer from gynecological conditions such as endometriosis, uterine fibroids, or excess male hormones. However, there is a higher risk of ovarian hyperstimulation.

Treatment schedule by days:

• On day 21, the doctor initiates suppression of pituitary activity

• With the onset of menstruation, ovarian stimulation begins, accompanied by ultrasound monitoring (10–14 days)

• 36 hours before the follicular puncture, an hCG injection is administered

• On day 14, the doctor performs the egg retrieval and the man provides a sperm sample

• 3–5 days after retrieval, fertilization occurs and is closely monitored

• On day 4, the embryo is transferred to the uterus

• Hormonal support continues for the next 14 days

• A blood test for beta-hCG is conducted two weeks later

The long protocol is recommended for women with a good follicular reserve when a high egg yield is expected.

How the IVF Protocol Is Chosen

IVF protocols differ in duration and the number of medications prescribed. The choice depends on the woman’s individual characteristics, presence of any conditions, and how her ovaries respond to stimulation—but the final decision is always made by the fertility specialist.

Key Considerations in IVF Protocol Selection

Choosing an IVF protocol is a strategic decision for the doctor. They assess potential risks and individual factors. For example, if a woman has had no ovulation for a long time, she may produce many eggs, but their quality may be low, resulting in few viable embryos. In such cases, long protocols are preferred. If IVF is being repeated and the reproductive system is healthy, the short protocol is often chosen.

Regardless of the protocol type, it is crucial for patients to undergo full medical evaluation and strictly follow the doctor’s recommendations. It’s also important to understand that egg quality depends on the individual’s genetic material and not on the skill of the reproductive specialist.