I would say that the long protocol is less controllable — at least controllable for us. I do quite like it, to be honest. It’s not like the first choice that would sort of pop up in my head, but if I do have patients having failures from the antagonist protocols, then most likely, I’m going to switch them to the long protocol. It requires high doses of the medication, so the highest load of medication has to be used in the long protocol.
That means we will use very high doses of FSH and right now there is a tendency to decrease using such types of protocols and we try to use fewer dosages, but enough on the growth of the cohort of follicles
It depends on how people think about aggressiveness. The question would be can you think of aggressive? In terms of dose of drugs? In terms of trying to maximize your egg yield you can use a high dose of drugs. You could think about it in terms of how frequent you’re doing cycles – in terms of being actually doing sort of dual stimulation where you’re having stimulation during your follicular phase of your cycle and then having an egg retrieval, then five days later you’re starting again going for more stimulation. You might think in terms of aggressive, in terms of kind of side effects and you know things were by GnRH agonist based protocols – you can have menopausal side effects with that and perhaps if you’re having to prolong down regulation you can be even more side effects if you’ve got a long-standing history of endometriosis for example. Aggressive can mean different things to different people and again it just reflects what protocol is being individualized for you.
Speaking of IVF protocols, I do not find one protocol that is aggressive to patients. They are all very tolerable and we no longer use high doses of gonadotrophin like four hundred and fifty as it is no use. So aggressive protocols may be only in specific patients such as PCOS, that we know have so many follicles in the ovaries, and they can react with a high response to the dose we are giving. This can be a risk that causes ovarian hyperstimulation syndrome. Now we have how to solve it as we trigger and complete final moderation of the follicles with a different type of medication and we don’t transfer the embryo in the first cycle so that way we can avoid the syndrome. So the protocols for IVF are no longer that aggressive.
There is no aggressive protocol. Each protocol will depend on the type of patient, however, within the last few years the most used protocol is the one with antagonists and according to the diagnosis the ovarian reserved and type of patient, we will decide on the protocol to use. Nevertheless the most used protocol is with antagonists but it is not an aggressive protocol.
