There is no single best protocol for endometriosis. The main challenge with these patients is that they often have a lower response compared to others due to endometriosis affecting ovarian reserve. Therefore, we need to customize the protocol based on individual factors, such as the presence of male factor infertility and the woman’s age. The chosen protocol should aim to achieve the desired number of eggs, typically between 10 and 15.
In artificial or reproductive treatment, I mean IVF, we are using two kinds of protocols commonly. Long protocol – we’re starting from the mid cycle until the period, until the start of the period and then we carry on this protocol until the time of triggering the ovulation. This stimulation is called a long protocol. The other protocol called antagonist protocol – we’re just starting from your second day of the cycle by giving stimulation medication and then triggering – give some hormone to suppress the ovulation and then stimulate the ovary. Commonly, nowadays, we only use antagonistic protocol which is the second protocol for most of our cases as it’s the same response like long agonist protocol.
The myth around endometriosis treatment – if we give suppression for longer time, will suppress the endometriosis and then we will have proper quality of IVF later on but this they found that it can prevent you to having some options, if you have a woman with PCOS or if you have a high responder woman, to deliver them a safe treatment at the end of the cycle. Currently, there is no difference between kinds of protocols in cases of mild and moderate endometriosis – no difference in the outcome or the live birth rate between both protocols. The benefits from antagonistic protocol which is the short protocol is we can trigger by something called the agonist medication and this medication will prevent formation of cysts later on and can help you also “freeze it all” if you have any symptoms of hyper stimulation (it’s a very nice medication). So no complete difference between the outcome: eggs outcome, live birth rate -no difference between both protocols.
