Written by
Monica Karpinski
Medically reviewed by
Kelda Gould
Fertility Nurse • BN in Adult Nursing
If you’re using your own eggs for IVF, you’ll need to go through stimulation. It’s the part of an IVF cycle where you take medicine to encourage your ovaries to grow more eggs.
Yet there’s different approaches to stimulation. The two main options are long and short protocols. There’s also the natural protocol, which uses much lower doses of medicine.
Your doctor will decide which is best for you. At ARGC, we weigh up your medical history, age, hormone levels, and more when making the call.
We’ve explained all three options below.
We have different protocols to support people in different situations.
Your body has its own biological profile: your hormone levels are unique to you. Your fertility health and medical history are your own. So, with all that in mind, your clinic will recommend a protocol that suits you best.
Here at ARGC, each and every treatment plan we create is unique to that person. The specific timelines and medicine schedule within each protocol are completely tailored to you, rather than being pre-set to the standard.
By the way, when we say “protocol”, what we mean is a plan of action. IVF protocols specifically describe the medicines you’ll take, in which doses and over what time period, to encourage your follicles (sacs the eggs grow in) to develop. Learn more about the steps in IVF treatment.
In a short protocol, you start taking stimulation medicines at the start of your menstrual cycle. Here, the medicines work alongside your body’s natural hormone levels to encourage follicle growth.
We’ve covered what to expect during stimulation in more depth in another article. But here’s an outline of how it works:
When you do IVF with us, you’ll come into the clinic on the first or second day of your period. We’ll do a blood test to check your hormone levels and do an initial scan. That evening, one of our nurses will ring you with your results plus instructions on which stimulation medicines you should take.
Then it’s time to take the medicines. You will give yourself daily injections under the skin (called subcutaneous injections) to stimulate your ovaries.
We take an extremely thorough approach to stimulation at ARGC. You’ll come into our clinic daily (sometimes, twice) for blood tests during this time. We’ll do regular scans, too. This is to see how the medication is affecting you, and to tell us whether you need to adjust your doses. We will call you every afternoon or evening with instructions for the following day.
After a few days of stimulation, you will start taking daily injections of a medicine called Cetrotide. This blocks your body’s natural rise in the hormone LH to prevent the eggs from being released too early.
When your follicles are mature enough (usually, this is when they are 16-22mm in size), you will take what’s called a trigger shot. It’s a hormonal medication that prompts your follicles to enter their final stage of maturation. The eggs will be ready for collection 34-36 hours after the trigger shot.
Generally speaking, a short protocol can be recommended for:
You could think of a short protocol as giving a kind of boost. The medicines work alongside your natural hormone levels, which gives stronger, immediate stimulation to your ovaries.
But the trade-off is that we have less control over your hormone levels than if we were to do a long protocol. More on this below.
A long protocol adds an extra step: before you start stimulation, you take downregulation medicines to suppress your natural hormone levels. This usually takes about 1-2 weeks.
Having this step lets us control your hormone levels much more precisely. It means that during stimulation, your levels are affected by the medicine only: your natural hormonal patterns don’t factor in. And this helps your follicles develop at a more even rate, while preventing the eggs from being released too soon.
A long protocol can be started during your luteal phase (around a week before you’d expect your period) or in the follicular phase, on day 1 or 2 of your period. Sometimes these are called luteal long protocols and follicular long protocols.
Your clinic might suggest one over the other depending on how regular your cycle is and when it’s most convenient for you to start treatment. For example, a luteal long protocol might be best if you have a predictable, regular cycle, because the start date is based on when you think your period will start.
After the downregulation phase, you’ll follow the same steps as the short protocol. That means that if you’re doing IVF with us, you’ll come into the clinic daily for blood tests and regular scans. And each afternoon or evening, we’ll give you instructions for what medicines to take the following day.
We may recommend a long protocol for people who:
Long protocols give us more control over your hormone levels. But in people with lower ovarian reserve, downregulation medicines can sometimes over-suppress the ovaries. This makes them more difficult to stimulate. That’s why a long protocol is often better for people with stronger ovarian reserve.
Finally, there’s the natural protocol. It’s an approach that uses minimal medication to develop and collect a smaller number of eggs (usually one or two).
A natural protocol works alongside your body’s natural menstrual cycle. We have less control over your hormone levels than with a long or short protocol, but it’s much easier on the body. Though because fewer eggs are collected, the chance of success may be lower.
A natural protocol starts when your period does. If you’re working with us, you’ll come in and have your hormone levels tested at this point. We want to make sure your ovaries are “quiet” (that is, follicles haven’t started growing yet) before you start stimulation.
Based on your test results, you might start medication right away or wait another few days for your hormones to shift naturally. With a natural protocol we may also wait to let the body start to pick its own dominant follicle, which we’ll then support with stimulation medicines.
Good to know: In a natural menstrual cycle, the body chooses one follicle to develop into maturity.
You’ll take low doses of stimulation medicine, plus medication to prevent premature ovulation, until your follicles grow big enough for the trigger shot. As with any other protocol, at ARGC you’ll see us every day for blood tests and regular scans throughout stimulation. We’ll tell you exactly what medication to take on each day.
When it’s time, you’ll take the trigger shot and prepare for egg collection. Learn what happens during egg collection.
Usually, this approach is only recommended in specific situations:
Your doctor will weigh up the risks and benefits of a natural protocol when deciding what’s best for you.
At ARGC, we will only recommend an IVF protocol after we have taken the time to understand your body, your situation, and your medical history thoroughly.
Before treatment starts, we monitor your body’s natural rhythms and patterns across the course of a natural menstrual cycle. This allows us to get the full picture of your fertility health. And with this insight, we will then build a treatment plan that’s precisely tailored to you.
Wondering whether ARGC is right for you? Our advisory calls are free, no-obligation, and led by someone who can answer your specific questions about treatment, costs, and what to expect. Book a free advisory call to get started.
Fertility Nurse • BN in Adult Nursing
Kelda Gould is a Registered Nurse specialising in fertility care. She holds a degree in Biochemistry and has over a decade of clinical experience spanning general nursing, outpatients, first response, and fertility care.
Why are there different IVF protocols?