Fertility Masterclass 9 - GnRH Agonist (LONG) Protocol | Ovulation Stimulation Protocols

Summary

In this fertility masterclass, Dr. J discusses the GnRH Agonist protocol, a standard IVF stimulation method. Ideal for normal responders and those with previous antagonist protocol failures, it's particularly beneficial for fresh transfers. Dr. J explains the physiological basis, practical steps, and special considerations like luteal phase support. He addresses concerns about OHSS and cost-effectiveness, highlighting the protocol's advantages, including flexibility and potential for higher-quality embryos.

Takeaways

• 🔬 The Agonist protocol is a standard IVF stimulation protocol, often used when other methods encounter difficulties.
• 📉 Less than 5% of IVF cycles globally use the Agonist protocol due to the convenience of the Antagonist protocol.
• 👩‍⚕️ The Agonist protocol is suitable for normal responders, those who have failed previous Antagonist attempts, and for fresh transfers with ample time.
• 💡 Post-surgery, for normal responders aged 35-40, the Agonist protocol may yield better results than the Antagonist protocol.
• 📅 The Agonist protocol involves administering a daily dose of a GnRH agonist, starting from cycle day 2 or 3.
• 🌡️ A critical aspect of the Agonist protocol is the initial rise in FSH and LH, which is essential for follicle recruitment.
• 💊 A typical daily dose of 0.1 ml triptorelin is administered, which helps in recruiting follicles and standardizing the cohort.
• 🚫 The Agonist protocol requires luteal phase support due to the potential defect in the corpus luteum formed.
• 🧪 Serum estradiol levels are monitored to determine if stimulation should begin, especially in the presence of a residual cyst.
• 💰 While the Agonist protocol may require a higher dose of HMG, the potential for additional high-quality embryos can offset the cost.
• 🌡️ The risk of OHSS (Ovarian Hyperstimulation Syndrome) is not a significant concern with the Agonist protocol under the specified conditions.

Q & A

What is the main focus of today's session on fertility masterclass?

The main focus of today's session is the GnRH Agonist protocol, which is a standard protocol for IVF stimulation.

Why is the Agonist protocol considered a go-to option in certain situations?

The Agonist protocol is considered a go-to option in certain situations such as for normal responders, after failed antagonist protocol attempts, and when a fresh transfer is desired with sufficient time available.

What are the special situations where the Agonist protocol is preferred over the Antagonist protocol?

The Agonist protocol is preferred in cases of endometriosis post-surgery, for normal responders, in the age group of 35 to 40, and when there have been previous failed attempts with the Antagonist protocol.

Why is the Agonist protocol beneficial for patients with endometriosis post-surgery?

In Dr. Jay's experience, the Agonist protocol works slightly better post-surgery for patients who are normal responders and are on the slightly higher side of age, between 35 to 40.

How does the Agonist protocol differ from the Antagonist protocol in terms of convenience?

The Antagonist protocol is considered more convenient as it is used in over 95 to 98% of IVF stimulation cycles worldwide, while the Agonist protocol is less commonly used as a standard.

What is the role of the late luteal phase rise in FSH in the context of the Agonist protocol?

The late luteal phase rise in FSH is important for the recruitment of a cohort of follicles, which is a key aspect of the Agonist protocol.

What is the significance of the initial flare caused by the Agonist protocol?

The initial flare caused by the Agonist protocol is significant as it helps in recruiting the follicles, which is crucial for the stimulation process.

Why is it important to give HCG as a trigger in the Agonist protocol?

HCG is the best trigger to work on the follicles in the Agonist protocol because it binds beautifully to the estrogen-dependent LH receptors that develop once the follicles reach a certain size.

What is the recommended luteal phase support for patients undergoing the Agonist protocol?

The recommended luteal phase support for patients in the Agonist protocol includes a combination of estradiol hemihydrate or valerate along with progesterone, starting the next day of the egg pickup.

Why is there a concern about the cost-effectiveness of the Agonist protocol?

There is a concern about the cost-effectiveness of the Agonist protocol because it requires a higher dose of HMG stimulation, which might increase the cost for the patient.

How does the Agonist protocol impact the risk of OHSS (Ovarian Hyperstimulation Syndrome)?

The Agonist protocol does not significantly increase the risk of OHSS, especially in normal responders, those with endometriosis, and those who have failed antagonist cycles.