Long protocol (USP) - down regulation – scheme 3
This protocol is based on the dual effect that may be obtained by using pituitary stimulation hormone (called GnRHa).
The products may hinder pituitary peak secretion and yields a low constant stimulation of this gland. By these effects ovulation may be controlled and by a slight stimulation of the glandular secretion an extra effert is added to the controlled hormone stimulation.
The protocol is initiated 1 week prior to the onset of expected menstruation; the products are either Synarela, Suprecur, Suprefact, Decapeptyl or Zoladex.
After approx. 2 weeks of partially inactivation of the pituitary gland and after the menstruation has cleared the endometrial lining – the stimulation may be commenced.
The controlled ovarian stimulation is done under the cover of pituitary control and by giving FSH or HMG stimulation (Gonal F, Puregon or Menopur). The follicular growth is controlled by ultrasongraphy.
When follicles are mature ovulation is induced by hCG injection (Pregnyl or Ovitrelle). This protocol appears to be the best in the more mature part of our women treated in the clinic and is in average “the overall winner”.