GnRH AgonistFSHShort Boost Protocol

This protocol (Fig. 3) is typically reserved for poor responders, namely patients with day 3 FSH >10 IU/L and patients with a previous IVF cycle in which they have been cancelled or less than three oocytes were retrieved ("poor responders'') or women who previously had a live delivery with a boost cycle. This protocol "boosts" the exogenous gonadotropin injected

Follicle Stimulation Protocol
Figure 3 A diagram of the procedures, monitoring, and medicines used for short or Boost protocol commencing on day 2 of the menstrual cycle. Abbreviations: GnRH, gonadotropin-releasing hormone; FSH, follicle-stimulating hormone; hCG, human chorionic gonadotrophin.

into the patient by a rise in serum concentration of her endogenous FSH. In this protocol, the GnRH agonist administration begins on day 2 of the cycle and FSH starts on day 3 of the cycle. Both medicines continue on the same regimen as the downregulation protocol. hCG administration criteria and dosage are the same as for the downregulation protocol.

The most important disadvantage of this protocol is the high P4 levels during the early follicular phase. This is most probably caused by rescue of the preceding corpus luteum. If the serum P4 is >6nmol/L in the late follicular phase, we recommend cancellation of the cycle. NICE guidelines confirm a decreased clinical pregnancy rate per cycle using the short protocol compared with the long GnRH agonist protocol. The relative cost of agonists in the various regimens required for IVF require further economic studies to ascertain whether there is any true difference in cost.

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